Care Providers of Minnesota presents one of its most popular and longest-running programs:
NURSE MANAGERS’ EDUCATION SERIES
While this signature certificate series is now a virtual experience, the quality of education and presenters upholds Care Providers of Minnesota’s high standards. Each module will be presented live, and participants have the opportunity to engage with presenters. In addition, each module will be archived and available for 30 days after live presentation.
NURSE MANAGERS’ EDUCATION SERIES FEBRUARY 23-APRIL 7, 2021
21.25 hours | 13 modules* | 13 speakers | 1 great learning opportunity The NURSE MANAGERS’ EDUCATION SERIES is designed for home care nurses who manage the multitude of tasks they face every day in assisted living, housing with services, and home care operations.
COMPREHENSIVE LEARNING EXPERIENCES & CAREER INVESTMENT—VIRTUAL EDITION
*Seven modules are shared with the Housing Managers’ Education Series
Nurse Managers' Education Series February 23 – April 7 | Virtual Event
FEBRUARY Tuesday, February 23 10:00 AM Wednesday, February 24 1:00 PM
AGENDA Nurse documentation—Best practices in charting April J. Boxeth, Attorney/Partner, Voigt, Rodè, Boxeth & Coffin Aaron M. Sagedahl, Attorney, Voigt, Rodè, Boxeth & Coffin
Medication management in assisted living & home care
Joe Litsey, RPh, PharmD, CGP, Director of Consulting Services, Thrifty White Pharmacy Services
MARCH Tuesday, March 2 1:00 PM Wednesday, March 3 10:00 AM Wednesday, March 10 10:00 AM Thursday, March 11 10:30 AM Wednesday, March 17 9:00 AM Wednesday, March 24 1:00 PM Thursday, March 25 1:00 PM Wednesday, March 31 1:00 PM
New Laws Affecting Assisted Living**
Jill Schewe, Director of Assisted Living, Housing & Home Care, Care Providers of Minnesota
Personalized dementia care—Bridging the gap between the person-centered approach & the human experience Krisie Barron, LSW, Caregiver Specialist, Embrace
Growing a Healthy Relationship—Housing Managers & Nurse Managers**
Amanda Johnson, Vice President of Clinical Operations, Tealwood Senior Living
Clinical care in a pandemic
Cindy Fronning, Director of Education, National Association of Directors of Nursing Administration in LTC (NADONA)
Legal Issues for Housing & Nurse Managers**
Rebecca K. Coffin, Attorney/Partner, Voigt, Rodè & Boxeth & Coffin Robert Rodè, Attorney/Partner, Voigt, Rodè, Boxeth & Coffin
Addressing Concerns & Complaints: When, How, & Why?**
April J. Boxeth, Attorney/Partner, Voigt, Rodè, Boxeth & Coffin Rebecca K. Coffin, Attorney/Partner, Voigt, Rodè & Boxeth & Coffin
Dealing with difficult behaviors
Randy Beckett, DNP, FNP-C, PMHNP-BC, Vice President Clinical Services, Encounter Telehealth
Leadership Beyond COVID-19: Re-Ignite the Passion Within**
Lisa Thomson, Chief Marketing & Strategy Officer, Pathway Health
APRIL Tuesday, April 6 1:00 PM 3:00 PM Wednesday, April 7 9:00 AM
Survey Preparation & Success**
Doug Beardsley, Vice President of Member Services, Care Providers of Minnesota
Electronic Monitoring **
Doug Beardsley, Vice President of Member Services, Care Providers of Minnesota
Clinical decision making in assisted living & home care settings
Dr. Robert G. Sonntag, MD, CRMD, Geriatrician, Medical Director, Health Partners
**Session is shared between the two signature education series CARE PROVIDERS OF MINNESOTA 7851 Metro Parkway, Suite 200 Bloomington, MN 55425
www.careproviders.org 1-952-854-2844 MN Toll-Free 1-800-462-0024
facebook.com/CPofMN twitter.com/CPofMN linkedin.com/company/CPofMN youtube.com/user/careprovidersofMN
2021 Nurse Managers' Education Series
Nurse Documentation: Best Practices in Charting CARE PROVIDERS
April Boxeth, Esq. aboxeth@vrb-law.com Aaron Sagedahl, Esq. asagedahl@vrb-law.com
FEBRUARY 23, 2O21
Voigt, Rodè, Boxeth & Coffin Law Firm 651.209.6161
*Remember – this presentation is for educational purposes only and is not intended to be legal advice. If you have legal questions, please consult a licensed attorney.
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INTRODUCTIONS April Boxeth, Esq., Attorney/fmr. Partner/Of Counsel, Voigt, Rodè, Boxeth & Coffin, LLC April J. Boxeth is of counsel at Voigt, Rodè, Boxeth & Coffin, LLC. Ms. Boxeth practices in the areas of health law, assisted living, long term care, senior housing, home care, hospice and adult day. Ms. Boxeth advises clients in the areas of regulatory compliance, behavior issues, guardian/conservator issues, probate law, accounts receivable, and general corporate matters and is a frequent presenter on all of these topics. Ms. Boxeth has worked in health law for more than 25 years; she is a former adjunct professor of the Business Law Practicum at William Mitchell College of Law and currently serves as faculty at the University of MN in the HSM/Long Term Care Management and Law course.
Aaron Sagedahl, Esq., Attorney, Voigt, Rodè, Boxeth & Coffin, LLC Aaron M. Sagedahl is an associate attorney at Voigt, Rodè, Boxeth & Coffin, LLC practicing in the areas of collections, healthcare law, regulatory compliance, and business formation. Mr. Sagedahl advises clients in the areas of licensure, regulatory, and corporate compliance and general corporate issues including business start-ups, surveys/appeals, and CHOWs. Mr. Sagedahl is a 2016 graduate from Mitchell Hamline School of Law.
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Objectives for Today’s Presentation
1 Know what you need to do to keep accountable, legal records
2 Timeframes for retention of documentation?
3 Best practices – what to do and what not to do!
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Communication: Verbal and Written Inter-department and intra-department Reading, following and discussing policies and procedures Documentation (see handouts - “21 Steps”) •Clear (“observe vs. monitor”) and concise (What is the issue? What did you do, are you doing, or will you do about it?) •Be action/intervention oriented •Prove and document that you tried and failed •Delegate nursing functions appropriately
Ask for help - work as a team- respond to issues timely Don’t forget RCA! - - surveyors won’t.
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Communication: Verbal and Written (cont.) Care Plan must be specific and complete in skilled care and home care Now almost daily documentation in home care and AL Must have good documentation •Payment •Level of care criteria •Care continuity
Leases and Services Agreements: broad enough to allow for eviction/termination Significant changes in condition Therapy documentation and nursing rehab documentation must match
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• Care Plans • Assessments – RCA! • Interventions
Document the following:
• Medication administration • Admission, Transfer and Termination of Services (soon to be called “discharge”) • Facility Assessments • Personal License Compliance and Board Review • Resident Rights
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• Suspicion of Crime/Neglect • Abuse, Neglect and Exploitation • Surveys
And Document the Following:
• Plans of Correction • Internal Reporting • External Reporting • OHFC/MAARC Reports • OHFC Investigations • Police Investigations • Appeals
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Initiative, Responsibility, Accountability • Take initiative, follow through, be accountable • Incorporate systems and audit the systems • Corporate Compliance in Home Care/Housing • Quality assurance and Quality incentives • Training/Education – Dementia training • Abuse Neglect Reporting and investigations • Citations for drug diversion and Bill of Rights violations • Legal Risk vs. Practical Risk Management
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Clinical Liability Issues
Legal:
License actions:
Fraud and abuse focus of Surveyors
Reports to Board of Nursing of serious violations and deficiencies
Negligence and wrongful death actions Criminal liability
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Clinical Liability Issues for Housing
Admissions in Housing/home care (Assisted Living Facility):
Assessments of Admission and ongoing
Clinical Expertise
Appropriate Staffing
CPR: Communicate Code Status and Update Policy
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Clinical Liability Issues (cont.)
Public Relations issues (Media attention to abuse and neglect and exploitation issues)
Ethical issues Negligent supervision Serious infractions and discipline Nurse delegation issues
Social Media Issues Policy and Procedures – cell phone Consistent enforcement of the rules
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Know Laws, Rules, Regulations and Guidelines • MDH interpretations • Survey & OHFC Focus: incidents and accidents, pain management, pressure sores, hydration and nutrition, Abuse/neglect/exploitation • Resident’s/Tenant’s/Client’s right to be free from same
• Top Deficiencies: Care/Service plans, Assessments and Interventions, Therapy management Employee records, Statement of Home Care services, Individual Abuse Prevention Plan, Policies and Procedures, Client record • Know clients and their conditions and diagnoses
• Trust good nursing judgment
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Document Retention
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Retention: What to Keep and For How Long Document Type
Federal Regulation
State Regulation
Medical Record
5 years from the date of discharge*
5 years from the date of discharge or death*
For supervised living facilities’ resident health records
3 years following discharge or death
For medical assistance providers, medical health care and financial records
* 7 years – OIG lookback
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The Legal Health Record: HIPAA • HIPAA privacy rule: organizations must identify a “designated record set” that is: (i) the medical records and billing records (ii) the enrollment, payment, claims adjudication or case or medical management record systems maintained by or for a health plan; or (iii) used to make decisions about individuals.
• This information is usually disclosed in response to authorized requests for copies of a patient health record.
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Documents and Data That Are Part of the Legal Health Record • Admission Record • Advance directives • Assessments • Allergy records • Analog and digital photos for ID purposes only • Anesthesia records
• • • • • •
• E-mail messages containing patient-provider or provider-provider communications regarding care or treatment of specific patients
• • • • • • •
• Emergency department records
•
• Care Plans • Consent Forms for care, treatment, and research • Consultation reports • Diagnostic images
• Graphic records (graphs) • History and physical examination records • Immunization records • Medication administration records
• • • •
Medication orders Medication profiles History and physical examination records Minimum data sets Operative and procedure reports Orders for treatment including diagnostic tests for laboratory and radiology Pathology reports Patient-submitted documents Patient identifiers (medical record number) Problem lists Progress notes and documentation Psychology and psychiatric assessments and summaries Records received from another healthcare provider if they were relied on to provide healthcare to the patient Research records of tests and studies from laboratory and radiology Standing orders Telephone messages containing patient-provider or providerprovider communications regarding care or treatment of specific patients Telephone orders Verbal orders
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• Any information oral or recorded
The Legal Health Record: Minnesota
• Relating to the past, present, or future physical or mental health or condition of a patient; • provision of health care to a patient; • or the past, present or future payment for the provision of health care to a patient.
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After Retention Period is Over • When a documents has reached the end of a retention period it should be destroyed. • At least annually, every facility should review the documents on the retention guideline and destroy records appropriately. • Acceptable methods include shredding, incineration, and pulverization.
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Write it down!
Practical Tips for Ensuring Quality Care and Good Documentation
Team analysis and critical thinking
Emphasis on outcomes
Creative treatments
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Positive attitude
What else can I do?
Mission focus
Keep smiling
Document
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Questions?
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Nurse Documentation: Best Practices in Charting CARE PROVIDERS FEBRUARY 23, 2O21
April Boxeth, Esq. aboxeth@vrb-law.com Aaron Sagedahl, Esq. asagedahl@vrb-law.com Voigt, Rodè, Boxeth & Coffin Law Firm 651.209.6161
*Remember – this presentation is for educational purposes only and is not intended to be legal advice. If you have legal questions, please consult a licensed attorney.
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21 STEPS TO LEGAL DOCUMENTATION 1.
Always follow facility policy and procedure for charting.
2.
Chart in black ink for handwritten entries; Log on and off for computerized entries.
3.
Include resident name and health record and Medical Assistance number on each page.
4.
Enter date and time per entry.
5.
Record data on the right form.
6.
Use standard abbreviations approved by facility. Understand the abbreviations.
7.
Sign each entry with first name, last name, and initials of your title. If you carry over to a new sheet, sign both entries; for computerized entry, only use your own name or ID number.
8.
Chart in chronological order. If entry is done out of order, enter date and time of when entry was to be made. Example: Charting for (date) .
9.
Use every line so your entry cannot be altered; for computer, follow prompts.
10.
Do not erase or write between the lines. If you make a mistake, draw a line through or circle the mistake, write “error” and initial the error.
11.
Record care as close as possible to the time it was provided.
12.
Document for the patients for which you care; do not use another Employee ID number.
13.
Record data you can SEE, HEAR, SMELL and TOUCH.
14.
Eliminate bias, judgment and labels.
15.
Do not generalize. Be specific – chart in measurable terms; inches vs. centimeters.
16.
Document symptoms in the resident’s own words.
17.
Ensure continuity by noting problem, nursing action taken, and changes in status.
18.
Document “magic words” such as what you did to: protect, identify (hazards, safety issue), evaluate, implement interventions, prevent, and monitor.
19.
Document all physician visits and consultations whether in person or by telephone.
20.
Document all discussion of questionable physician orders especially if confirming, canceling or modifying of orders. Include time and date and actions as a result.
21.
It is not enough to chart changes in condition, refusal of Meds/Tx. What are you going to do about it? What did you do about it?
2021 Nurse Managers' Education Series
MEDICATION MANAGEMENT IN ASSISTED LIVING & HOME CARE February 24, 2021
Joe Litsey, RPh, PharmD, CGP, Director of Consulting Services Thrifty White Pharmacy
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Thank you to our sponsor
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We are dedicated to: Proactive care, reducing medical cost and patient stress Better serving those in traditional care settings Leading change in the overall healthcare system
Bluestone is a preventative primary care clinic created to uniquely serve those in senior living communities and group homes through on‐site visits. We believe that a close partnership with community staff, families, and other care team members is the best way to deliver customized, quality health care. Bluestone patients benefit from regularly scheduled, proactive care for their chronic conditions, including dementia. Bluestone Physician Services Minnesota/Wisconsin: 651-342-1039 Florida: 844-795-4513
Accepting new patients in the Twin Cities metro! Expansion to Faribault area – Spring 2021
www.bluestonemd.com 3
Medication Management In Assisted Living and Home Care Joe Litsey, Pharm.D. Board Certified Geriatric Pharmacist Director of Consulting Services – THRIFTY WHITE PHARMACY
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INTRODUCTIONS
Joe Litsey, RPh, PharmD, CGP, Director of Consulting Services, Thrifty White Pharmacy Joe Litsey has worked with Thrifty White Pharmacy as a consultant pharmacist for 19 years. He is currently the Director of Consulting Services. In this role, Joe works with LTC communities and pharmacists developing best practice medication management programs. Joe earned his Doctor of Pharmacy degree from North Dakota State University in 1994 and has specialized in geriatric medication management since the onset of his professional career. Joe is Board Certified in geriatric pharmacy, past president of the American Society of Consultant Pharmacists of MN, is a member of the MN Assoc. of Geriatrics Inspired Clinicians and routinely provides medication related education.
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OBJECTIVES • Describe the relationship of medication adherence to medication management and patient outcomes. • Understand hazardous waste pharmaceutical management requirements. • Understand hazardous drug management requirements • Identify best practice recommendations for handling and accountability of controlled medications • Discuss new legal requirements for controlled medication dispensing in MN • Discern the hot topics of medication management
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MEDICATION MANAGEMENT
Non‐adherence to medication regimens is a major cause of nursing home placement of frail older adults. Lewis A. Non-compliance: a $100 billion problem. The Remington Report. 1997; 5(4):14-5.
The ability to remain independent depends largely on a patient’s ability to manage their medication regimen.
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MEDICATION MANAGEMENT HOME CARE VS. SKILLED CARE MN Home Care
Skilled Nursing
Know the rules
Know the rules
• www.health.state.mn.us/facilities/regulati on/homecare/laws/index.html • Medication management: 144A.4791
• www.cms.gov/Medicare/ProviderEnrollment-andCertification/GuidanceforLawsAndR egulations/Nursing-Homes
Recent Survey Results: • www.health.state.mn.us/facilities/regulati on/homecare/consumers/surveyresults.h tml
Recent Survey Results: • www.health.state.mn.us/facilities/regulati on/directory/surveyfindings.html
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MEDICATION MANAGEMENT HOME CARE COMPREHENSIVE HOME CARE PROVIDER (CHCP) • Medication management services must develop, implement, and maintain current written medication management policies and procedures. • The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current standards of practice.
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MEDICATION MANAGEMENT HOME CARE
Comprehensive – P&P must address:
Requesting and receiving RX’s Preparing and giving medications (including medication setup) Verifying medications are administered as prescribed Documenting medication management activities Controlling and storing medications Monitoring and evaluating medications Resolving medication errors Communicating with prescriber, pharmacist, client/representative Disposing of unused medications Educating clients and client representatives about medications CS P&P must address security and accountability and disposition
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MEDICATION MANAGEMENT HOME CARE
Provision of medication management services. • For each client on medication management services, the CHCP shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber conduct an assessment to determine what medication management services will be provided and how they will be provided. 11
Medication Management Assessment
MEDICATION MANAGEMENT HOME CARE Must be conducted face-toface with client or client representative Must include identification and review of all medications the client is known to be taking – including Medication:
Indications Side effects Contraindications Allergic or adverse reactions And actions to address these issues
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MEDICATION MANAGEMENT SKILLED NURSING New Tag
Corresponding Old Tag
F755
Pharmacy services, Procedures, Records
F425 and F431
F756
Drug Regimen Review, Report, Action
F428
*F757
Drug regimen free from unnecessary drugs
F329
*F758
Free from unnecessary psychotropic medications and PRN use
F329 and F428
*F759
Free of medication error rate ≥ 5%
F332
*F760
Free of significant medication errors
F333
*F761
Labeling and storage of drugs and biologicals
F431
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MEDICATION MANAGEMENT SKILLED NURSING Other tags that may affect pharmacy services New Tag
Corresponding Old Tag
*F600
Free from Abuse and Neglect
F223
F655-F661
Comprehensive Resident Centered Care Plans
F483-F484
*F684
Quality of Care
F309
*F744
Treatment/Service for Dementia
F309
F865 – F868
Quality Assurance Performance Improvement (QAPI)
F520
F880; F881; Infection Prevention and Control; ABX F882 Stewardship; Infection Preventionist
F441
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All things pertaining to medication use
MEDICATION MANAGEMENT (MY DEFINITIONS)
Evaluation
Adherence Indication Administration Monitoring Dose/Duplication Duration
Handling
Storage Accountability Procurement Other
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MEDICATION MANAGEMENT
The ability to remain independent depends largely on a patient’s ability to manage their medication regimen. Non‐adherence to medication regimens is a major cause of nursing home placement of frail older adults. Lewis A. Non-compliance: a $100 billion problem. The Remington Report. 1997; 5(4):14-5.
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MEDICATION MANAGEMENT AND PATIENT OUTCOMES Poor Medication Management Consequences • Medication non-adherence is a major cause of hospital and nursing home admissions. • In the US: ~3 million older adults are admitted to nursing homes due to drug-related problems; > $14 billion. • Hospital admissions of older adults are often drug related: • Adverse Drug Related • Adherence related • Older adults discharged from hospital on multiple medications are at greater risk of hospital readmission. • Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. • Glans, Ekstram, et al, Risk Factors for Hospital Readmission in older adults within 30 days of discharge – retrospective study. BMC Geriatrics Article number: 467(2020)
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MEDICATION ADHERENCE **Adherence: Describes the degree to which a patient correctly follows medical advice. • 75% of Americans have trouble taking medications as prescribed • Patients with common long term health conditions (ex: asthma, diabetes) take their medication as directed 50-60% of the time. • 125,000 deaths each year due to medication non-adherence • estimated that cost of medication non-adherence is nearly 300 billion dollars every year. 1. 2. 3. 4. 5. 6.
National Community Pharmacists Association and Pharmacists for the Protection of Patient Care Adherence Survey 2006. American College of Physicians, “Costs and Quality Associated with Treating Medicare Patients with Multiple Chronic Conditions,” 18 May 2009 Sabate E., et. al., Adherence to Long-Term Therapies, World Health Organization (2003) US Center for Disease Control and Prevention, “Chronic Disease Overview,” available at http://www.cdc.gov/NCCdphp/overview.htm McCarthy R. The Price You Pay for the Drug Not Taken. Business Health 1998;16:27-33. R Balkrishnan, “The Importance of Medication Adherence in Improving Chronic Disease Related Outcomes,” Med Care 2005: 517-20.
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MEDICATION ADHERENCE Primary Non-Adherence (medication was never even picked up/never taken)
3 main types of Discontinuation (medication stopped too early) nonadherence Non-Execution (patient is actively engaged in therapy but uses medication in a way that is inconsistent with provider recommendations: skip doses, split pills, incorrect technique…)
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MEDICATION SYNCHRONIZATION PROGRAMS • The World Health Organization reported that >25% of medications are never even picked up from the pharmacy. • Thrifty White Medication Synchronization Program: www.thriftywhite.com/Med_Sync.cfm • All medications are picked up at the same time, on the same day each month. • Scheduled calls placed to the patient before the appointment day. • On appointment day, pharmacist goes through the entire medication profile with the patient, and can address any medication related concerns.
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MEDICATION MANAGEMENT – THE FLIP SIDE OF NON-ADHERENCE • Polypharmacy • Duplication of Therapy
Medication Adherence
• Prescribing Cascades • High Risk Medications • Unnecessary Medications • Drug-Drug Interactions • Drug-Disease Interactions • Dosages too High
Unnecessary Medications
• Duration of Therapy too Long 22
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MEDICATION MANAGEMENT – PATIENT OUTCOMES AND READMISSIONS Improper medication administration / non-adherence leads to: • medication errors, • adverse drug events, • increased liability risk.
Identifying patients requiring medication management services has been shown to improve medication adherence.
Medication Regimen Review (MRR) have demonstrated a reduction in polypharmacy in older adults and decreased adverse drug events in older adults.
Improved adherence has shown to improve patient outcomes.
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MEDICATION MANAGEMENT - INDICATION
Presence
Accurate
Location
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MEDICATION ADMINISTRATION
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THE “8” RIGHTS OF MED ADMINISTRATION RESIDENT
Identify RESIDENT - name, DOB, Picture NEVER administer meds to more than one resident at a time Ask the resident to identify self Use technology when possible
MEDICATION
Check MEDICATION label and compare it to the order on the MAR entry three times Read the label to the resident and verify the resident understands the drug dosage and reason for use
DOSAGE
Triple check dose with label/MAR Watch split tablets—verify tablet strength/order strength Check the DAY OF THE WEEK Use the metric measuring system and standardized measuring devises
TIME
Watch MEAL sensitive medications Consider Personalized Medication Administration Policy
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THE “8” RIGHTS OF MED ADMINISTRATION ROUTE
Check the ROUTE—Confirm that the patient is able to receive via this route of administration.
DOCUMENTATION
Properly document each dose Document administration AFTER giving NEVER use pencil or use white out Document refusal of medication per your facility’s policy
REASON
Revisit the reasons for medication use—If you are unsure of the reason for use, ASK! Confirm Resident understands why they are taking
RESPONSE
Ensure the drug led to the desired effect Pay especially close attention when there is a medication change.
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ADMINISTRATION ERRORS Timing
Crushing or Chewing
Technique
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“DO NOT USE” ABBREVIATIONS: • Joint Commission 2011 • http://www.jointcommission.org/assets/1/18/Do_Not_Use_List.pdf • • • • • • •
“U” – Unit “IU” – International Unit Q.D.; QD; q.d.; qd – Every Day Q.O.D; QOD; q.o.d.; qod – Every Other Day X.0 – Trailing Zero 0.X – Leading Zero MS; MS04; MgSO4 – Morphine Sulfate vs. Magnesium Sulfate
Refer to resources provided
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HAZARDOUS DRUGS (USP-800) EFFECTIVE 12/1/19 • Hazardous Drugs (HD) - Possess one or more of the following: • • • • •
Teratogenic Carcinogenic Genotoxicity Reproductive toxicity Organ toxicity (at low doses)
Antineoplastic: Possess one or more of the properties of a HD Non‐antineoplastic: Possess one or more of the properties of a HD but are not antineoplastic Reproductive Risk: Drugs that primarily pose a reproductive risk to men and/or women actively trying to conceive and women who are pregnant or breast feeding
For further information, refer to the CDC website: www.cdc.gov/niosh/docs/2016‐161/default.html https://www.cdc.gov/niosh/docs/2016‐161/pdfs/2016‐161.pdf?id=10.26616/NIOSHPUB2016161
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HAZARDOUS DRUG LIST This list of Hazardous Drugs is not an ALL INCLUSIVE LIST. Drugs appearing in BOLD are often seen in the LTC setting. Generic
Brand
Megestrol Methotrexate Tamoxifen Carbamazepine Cyclosporine Valproic Acid Estrogens estrogen/progesterone methimazole Oxcarbazepine Phenytoin Raloxifen Rasagiline Spironolactone Tacrolimus
Megace Soltamox Tegretal Sandimmune Depakote Premarin & other Various Tapazole Trileptal Dilantin Evista Azilect Aldactone Prograf
Hazardous Drug Classification
Drug Classification
Antineoplastic Antineoplastic Antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic Non‐antineoplastic
Antineoplastic Antineoplastic Antineoplastic Anticonvulsant Immunosuppressant Anticonvulsant Estrogen Estrogen AntIthyroid Anticonvulsant Anticonvulsant Estrogen antagonist/agonist Antiparkinson Diuretic Immunosuppressant
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HAZARDOUS DRUG LIST This list of Hazardous Drugs is not an ALL INCLUSIVE LIST. Drugs appearing in BOLD are often seen in the LTC setting. Generic Clonazepam Colchicine dronedarone Dutasteride Eslicarbazepine Finasteride Misoprostol Paroxetine Temazepam Testosterone Warfarin Ziprasidone Zoledronic Acid Zonisamide
Brand Klonopin Colcrys Multaq Avodart Aptiom Proscar Cytotec Paxil Restoril Various Coumadin Geodon Reclast Zonegran
Hazardous Drug Classification Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk Reproductive risk
Drug Classification Benzodiazepine Anti‐gout antiarrythmic 5 Alpha‐reductase inhibitor Anticonvulsant 5 Alpha‐reductase inhibitor Prostaglandin SSRI antidepressant Benzodiazepine Androgen Anticoagulant Antipsychotic Osteoporosis Anticonvulsant
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HAZARDOUS DRUG HANDLING PROCEDURES
Formulation
Activity Receiving, All types of unpacking, Hazardous Drugs storage Administration Intact from unit‐dose tablet/capsule package **Cutting, Tablet/capsule crushing, manipulating Administration Tablet/capsule (non‐UD package) Oral liquid
Compounding
Double chemotherapy gloves
Eye/face Protective gown protection
Respiratory protection
No (single glove Yes (when spills / No can be used) leaks)
Yes (when spills / leaks)
No (single glove No OK)
No
No
Yes
No
Yes (if not done in a control device)
No (single glove No OK)
Yes (if vomit/spit up)
No
Yes
Yes (if not done in a control device)
Yes (if not done in a control device)
Yes
Yes
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HAZARDOUS DRUG HANDLING PROCEDURES
Formulation
Activity
Double chemotherapy gloves
Topical drug
Administration
Yes
SQ/IM injection
Preparation
Yes
Yes
Yes (if not done in a control device)
SQ/IM injection Administration
Yes
Yes
Yes (if liquid that No may splash)
Powder/Solutio n for inhalation
Administration
Yes
Yes
Yes (if liquid that Yes (if inhalation may splash) potential)
Spills
Cleaning
Yes
Yes
Yes
Eye/face Protective gown protection Yes (if liquid that Yes may splash)
Respiratory protection Yes (if inhalation potential) Yes (if not done in a control device)
Yes
https://www.cdc.gov/niosh/docs/2016‐161/pdfs/2016‐161.pdf?id=10.26616/NIOSHPUB2016161
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MEDICATION MONITORING DRUG
Intended effect
Side effect
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MEDICATION DOSE & DUPLICATION
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DOSE/DUPLICATION – FURTHER DISCUSSION • Is dose identified? (eye drops, inhalers, etc.) • Dosing Ranges? – AVOID if possible; If used: • Consistent parameters should be established • Dose must be documented
• Poly-pharmacy
• Multiple psychotropic medications • Multiple PRN medications (psychotropics, analgesics) • Anticholinergics
Avoid Multiple PRNs-same condition Avoid Dosing Ranges
Lorazepam 0.5mg 1-2 tabs Q4-6hrs PRN anxiety Seroquel 25mg-50mg Q4hrs PRN anxiety Hydrocodone/APAP 5/325 1-2 tabs Q4-6hrs PRN Oxycodone/APAP 5/325 1-2 tabs Q4-6hrs PRN
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PRN MEDICATION – HOW MUCH? • Use the lowest dose possible • “Take 1-2 tablets Q6hrs PRN”. What to do? • Try taking one and reevaluating • Or: “take one tablet Q6hrs PRN (may repeat 1x within ____ minutes/hours” • If no symptomatic relief seen within usual onset time (usually 30-60 minutes for pain meds), titrate up if second dose is consistently repeated.
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MEDICATION MANAGEMENT-DURATION
How Many Medications are indicated for… THE REST OF YOUR LIFE?
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DURATION – FURTHER DISCUSSION DEMENTIA
Antidepressants
Antipsychotics
Hypnotics
Cognitive enhancers
Cough, Cold Allergy Meds
Antihistamines
Eye drops
Urinary incontinence
Antibiotic prophylaxis
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HIGH RISK MEDICATIONS (HRM)
Overview of Beer’s Criteria • American Geriatric Society – Updated 2019 • 2019 pocket guide available through The American Geriatrics Society: www.americangeriatrics.org • Potentially Inappropriate Medication Use in Older Adults Medications to AVOID Medications to AVOID with certain disease states/conditions Medications to be used with CAUTION Medications to be used with CAUTION with certain disease states/conditions • Medications to be avoided or dose adjusted based on kidney function • • • •
Common Themes: • Medications with Anticholinergic Side Effects • Medications that may contribute to falls
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FALLS – INCIDENCE AND COST • Each year, >1 in 4 Americans over the age of 65 will experience a fall.
• Leading cause of fatal injury in older adults • Most common cause of nonfatal trauma-related hospital admissions among older adults
• Annually Result in:
• In 2015, total cost of fall injuries - $50 million • The average hospitalization cost for a fall injury is >$30,000 • Costs of treating fallrelated injuries increases with age
• 2.8 Million Emergency dept. visits • 800,000 Hospitalizations • 28,000 Deaths
Falls-Older Adults. Centers for Disease Control and Prevention website: https://www.cdc.gov/features/older-adult-falls/index.html. Updated September 22, 2017. Accessed May 13, 2019. Falls Prevention Facts. National Council on Aging website: https:// www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/ Accessed May 13, 2019.
Falls-Older Adults. Centers for Disease Control and Prevention website: https://www.cdc.gov/features/older-adult-falls/index.html. Updated September 22, 2017. Accessed May 13, 2019.
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FALLS • Medications increase the risk of falls and fall-related injuries, especially when their use is potentially inappropriate. • CDC - drugs that affect the CNS such as anti-anxiety drugs or sedative drugs are the most dangerous. • Patients are at increased risk of falling within 3 days of any adjustments to medication that may effect the CNS.
• Medications affecting blood pressure (orthostatic hypotension)
Falls-Older Adults. Centers for Disease Control and Prevention website: http://www.cdc.gov/HomeandRecreationalSafety/Falls/index.htm. Updated October 7, 2014. Accessed February 11, 2015.
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MEDICATION RELATED FALLS - ELDERLY • Sensitive Population • General decreased drug elimination • More sensitive to orthostatic hypotension • More sensitive to anticholinergic properties Anticholinergic Effects Dry Mouth, Dry Eyes
Confusion, cognitive impairment
Increased BP, Increased Constipation HR Dizziness
Drowsiness
Fatigue
Vision problems: blurred vision, worsening glaucoma, photosensitivity
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MAJOR CAUSES OF MEDICATION RELATED FALLS Most medication related falls are related to medications that may cause:
• • • • •
Sedation/fatigue Decreased alertness Postural hypotension Dizziness Decreased neuromuscular function
• • • • • •
Cognitive impairment Blurred vision Confusion Arrhythmias Syncope Urinary Urgency
Information for following slides taken from the American Geriatric Society AGS 2015 Updated Beers Criteria for Potentially
Inappropriate Medication Use in Older Adults
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MEDICATION CLASSES - FALLS
Opioid Analgesics
Anticholinergics
Anticonvulsants
Muscle Relaxants
Cardiovascular
Psychotropics
• Blood pressure • Rhythm Control • Angina
• Antipsychotics • Anxiolytics • Antidepressants
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ANTICHOLINERGIC MEDICATIONS • These medications are strongly anticholinergic, and should be minimized and avoided when possible in the elderly population. • • • • • • •
Tricyclic Antidepressants Antihistamines Antiparkinson medications Skeletal Muscle Relaxants Antipsychotics-especially 1st generation (typical) Antimuscarinics (urinary incontinence medications) Antispasmodics
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ANTICHOLINERGIC SIDE EFFECTS Reduce GI motility
Clumsiness
Drug 2
Drug 1 Drug 3
Unsteadiness
Cognitive decline
Confusion Irritability
Memory loss Dry mouth, nasal passages, eyes, skin
$ QWLFKROLQHUJLF 6LGH (IIHFWV
Constipation
Lethargy, fatigue, dizziness
Blurred vision Dizziness
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ANTICHOLINERGIC COGNITIVE BURDEN LIST (ACB) 1 = possible anticholinergic effects 2 & 3 = established & clinically relevant anticholinergic effects If score ≥ 3; consider alternative medications
Rating scale (1)
Rating scale (2)
Rating scale (3)
Digoxin (Lanoxin)
Loratadine (Claritin)
Amitriptyline (Elavil)
Furosemide (Lasix)
Cyclobenzaprine (Flexeril)
Olanzapine (Zyprexa)
Metoprolol (Lopressor)
Tiotropium (Spiriva)
Diphenhydramine (Benadryl)
Ranitidine (Zantac)
Carbamazepine (Tegretal)
Oxybutynin (Ditropan)
Risperidone (Risperdal)
Tolterodine (Detrol)
Trazodone
Paroxetine (Paxil)
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CASE STUDY: 1 Medication
Dose/route
Frequency
Ach score
Digoxin
0.125mg
Daily
1
Furosemide
40mg
Daily
1
Olanzapine
5mg
Daily
3
Carbamazepine
200mg
Three time daily
2
Diphenhydramine
25mg
QHS PRN
3
Paroxetine
20mg
Daily
3
Norvasc
10mg PO
QD
Simvastatin (Zocor)
40mg PO
QD
Metoprolol Succ.
100mg PO
Daily
1
Oxybutynin ER
10mg
Daily
3
Oxycodone
5mg
Q4‐6hrs PRN
Zantac
150mg PO
Twice Daily
Albuterol Inhaler
2 puffs
4x/day PRN
Total Score:
1
18
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STEADI – STOPPING ELDERLY ACCIDENTS, DEATHS, AND INJURIES • CDC Initiative – Aim to reduce falls, improve health outcomes, and reduce healthcare expenditures. • Three Core Elements: • Screen patients for fall risk • Assess modifiable risks factors • Intervene to reduce risk
• Free Resources for Patients and Providers https://www.cdc.gov/steadi/index.html
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CONSULTANT PHARMACIST REVIEW • Any new medications? Recent changes to medication doses? • Potential Drug Interactions • Timing of medications, proper administration techniques (i.e. meds with food) • Recommend proper monitoring of medications
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MEDICATION HANDLING Medication storage • Locked, clean, proper temperature • Multi-dose vials dated • Refrigerator 36-46 degrees F • Room Temp: < 86 degrees F • Internal and External stored separately
Medication Accountability • Know the controlled substances • Procurement procedures • No meds unattended or unaccounted for • No open or ‘taped’ unit dose packets • Shift counts • Shift count log book • Disposal
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THE OPIOID CRISIS The United States has less than 5% of the worlds population, but uses 80% of the global supply of opioid medications CNBC In 2012 HCP wrote 259 million Rxs for opioids – enough for every adult in the US to have a bottle of pills. CDC prescribing guidelines Since the 1990s, the amount of opioids prescribed began to grow, the number of overdoses and deaths from RX opioids also increased. Even as the amount of opioids prescribed for pain has increased, the amount of pain that Americans report has not similarly changed. CDC From 1999 to 2017, almost 218,000 people died in the US from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were 5x higher in 2017 than in 1999. CDC
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HISTORY OF OPIUM AND OPIOIDS • Opioids are drugs derived from or related to Opium • Opioids and Opiates – interchangeable
• Opium is derived from the juice of the opium poppy, Papaver somniferum • Opiates - one of the oldest types of drugs in recorded history • Dating back to the 3rd century BC
• Greeks dedicated the Opium poppy to the Gods of: • Death (Thanatos) • Sleep (Hypnos) • Dreams (Morpheus)
“Natural” substances
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CONTROLLED SUBSTANCES Description I
II
III
IV
V
High potential for abuse No currently accepted medical use Not considered safe High potential for abuse Accepted medical use Abuse my lead to severe dependence Potential for abuse-less than Schedules I &II Accepted medical use Abuse may lead to low/moderate physical dependence; high psychological dependence
Examples Lysergic acid diethylamide (LSD), Heroin Oxycodone, Hydrocodone, Morphine; Hydromorphone, Fentanyl, Methylphenidate
Acetaminophen with Codeine; Anabolic Steroids (testosterone)
Low potential for abuse relative to CIII Accepted medical use Abuse→limited dependence relative to CIII
Benzodiazepines (Lorazepam), sedative hypnotics (Zolpidem)
Low potential for abuse relative to CIV Accepted medical use Abuse→limited dependence relative to CIV
Guaifenesin with Codeine; Pregabalin
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Diacetylmorphine? 57
CHEMICAL STRUCTURE OF OPIATES
Morphine
Codeine
Hydrocodone • Basically the same! Bind to the same brain receptors • Heroin = Diacetylmorphine • 2 acetyl groups – more fat soluble - crosses blood-brain barrier quicker
Heroin
• 1/2 conversion Heroin/Morphine
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THE OPIOID RECEPTORS Response
Mu-1
Mu-2
Kappa
Analgesia
X
X
x
Respiratory Depression
x
Euphoria
x x
Dysphoria Decrease GI motility
x
Physical Dependence
x
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HISTORY China (opium den)
ADVICE TO MOTHERS!—Are you broken in your rest by a sick child suffering with the pain of cutting teeth? Go at once to a chemist and get a bottle of MRS. WINSLOW’S SOOTHING SYRUP. It will relieve the poor sufferer immediately. It is perfectly harmless and pleasant to taste
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Today
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2016 NUMBER AND AGE-ADJUSTED RATES OF DRUG OVERDOSE DEATHS BY STATE (PER 100,000) 6.9-11.0 11.1-13.5 13.6-16.0 16.1-18.5 18.6-21.0 21.1-52.0
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THE MOST COMMON DRUGS INVOLVED IN OVERDOSE Oxycodone Hydrocodone Methadone Fentanyl Heroin 65
FENTANYL & CARFENTANIL • Illegal fentanyl is being transported to the United States from China and Mexico • mixed in with heroin to make heroin more potent • Causing an increase in fatality rates among users
5 overdoses: Jan. 30 - Feb. 17 2017 in Minneapolis, Apple Valley and Faribault – Represent the first known carfentanil deaths in Minnesota
Shown above are lethal doses of white heroin versus synthetic opioids fentanyl and carfentanil.
Drug
Morphine conversion
Heroin
2x more
Fentanyl
100x more potent
Carfentanil 10,000x more potent
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Healthcare Availability • Drug abuse rates of healthcare workers are comparable to the public, however, prescription drug misuse is higher. • Healthcare workers who used daily and had easier perceived access with poor control - had 2x greater odds of using. • As access rose, so did misuses Prescription‐type drug misuse and workplace Access among nurses. Journal of Addictive Diseases, 18(1), 9‐17
Signs of Diversion in Healthcare Volunteering to administer medications for others Volunteering to hold narcotic keys or perform shift count Their patients receive more PRN pain medications but report non-effective pain relief. Frequent reports of lost or wasted medications. Individual may request to work in an area of high pain medication administration. Sloppy record keeping, frequently ‘forgetting’ to chart Volunteering to work night shift or in settings with few staff Frequent absenteeism/disappearances: multiple restroom breaks, arriving late/leaving early.
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Signs of Drug Tampering • Damaged/cut foil • Taped foil • Torn packets • Puncture holes • Appearance of tabs/caps/liquid • Viscosity of liquid • Uneven fluid levels
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CDC GUIDELINES FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN 1. Non-pharmacologic therapy and non-opioid therapy are preferred for chronic pain • Risks/benefits; combine with non-pharmacologic and non-opioid therapy.
2. Before starting and periodically during therapy: discuss risks/benefits • Informed consent and pain contracts
3. Prescribe the lowest effective dosage • Reassessment of risks and benefits should be done when increasing the dosage to ≥50 morphine milligram equivalents (MME/day) • Clinicians should avoid increasing the dosage to ≥90 MME/day
4. Acute pain treatment should be limited to 3 days or less; no more than 7 days
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CDC GUIDELINES FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN 6. Chronic pain should be evaluated within 1-4 weeks of starting opioid therapy 7. When starting opioid therapy for chronic pain - use immediate release opioids instead of extended release opioids • Methadone should not be the 1st choice for a long acting opioid • Transdermal fentanyl should only be prescribed by clinicians familiar with dosing/absorption properties of the drug
8. Avoid the concurrent use of opioid and benzodiazepines
Minnesota Opioid Prescribing Guidelines CDC Opioid Prescribing Guidelines www.mn.gov/dhs/opioid-guidelines www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
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PATHWAY TO MONITOR FOR THE DIVERSION OF CONTROLLED SUBSTANCES www.apiariconsulting.com/mn-drug-diversion
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CONTROLLED SUBSTANCE ACT AND LTC • The CSA primarily addresses two settings: • Retail pharmacy (prescriptions) • Hospital settings (chart orders)
• LTC pharmacy is really a hybrid model
• LTC facilities resemble the hospital setting • LTC pharmacies, often located off-site, licensed/registered as retail pharmacies
• LTCFs may administer medications pursuant to a chart order however the LTC pharmacy can only dispense controlled substances pursuant to a prescription meeting state and federal specific regulations. • NO controlled drug can be dispensed without a valid prescription authorized by an authorized practitioner • All prescriptions must be written for a specific patient and not issued for the purpose of general dispensing to patients.
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REQUIRED ELEMENTS OF A VALID PRESCRIPTION 1. Written in ink, indelible pencil or computer printed/generated 2. Patient’s full name and address 3. Practitioner’s name, address, and DEA registration number 4. Drug name, strength, dosage form, quantity prescribed 5. Specific direction for usage 6. Refill information 7. Date and signature of prescriber on issue date
PRESCRIPTION REQUIREMENTS BY SCHEDULE • Refills • Schedule II: No refills • Schedule III-IV: Prescription can not be dispensed after 6 months from date of issue or refilled more than 5 times • Fax • Schedule II: A fax may serve as the original when faxed to dispensing pharmacy from prescriber or authorized agent • SNF or Hospice
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RECEIVING ORDERS AND SENDING TO PHARMACY Refers to all orders (not just controlled substances) • Orders can be written on paper or electronic • Written orders must be signed by the prescriber • Electronic orders must be electronically signed by prescriber
• Facility must either deliver or fax the prescriber’s written and/or faxed order to the pharmacy. Any verbal order that was reduced to writing by the nurse will also need to be delivered or faxed to the pharmacy. • Orders can be entered into eMAR system, but the eMAR is not a valid prescription and cannot be used by pharmacy to dispense medication. • Written orders cannot be transmitted to pharmacy as verbal orders.
• Unlicensed facility personnel (HUC, TMA, etc...) cannot be involved, in any manner, in receiving, transcribing, transmitting prescriptions.
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2019 NEW PHARMACY LEGISLATION • Opioid Prescriptions Quantity Limits: • Acute pain • NMT 7 days for an adult and NMT 5 days for a minor <18 yo • Acute dental pain: 4 day supply *If in professional judgment of prescriber greater amounts may e prescribed. Pharmacist should me a reasonable effort to determine if prescription is for chronic/acute pain.
• Acute pain definition • Pain resulting from disease, accidental or intentional trauma, surgery, or another cause, that the practitioner reasonably expects to last only a short period of time. • Acute pain does not include chronic pain or pain being treated as part of cancer care, palliative care, or hospice or other end-of-life care.
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2019 LEGISLATION: OPIOID TIME LIMITS • Opioid prescription time limits: • Can not be dispensed > 30 days after it was written • Note: any prescriptions with start dates later than 30 days after the written date will no longer be valid.
• No subsequent refills may be dispensed more than 30 days after the previous date of filling (even if refills remain on the prescription) • Note: Prescriptions for Schedule III or IV opiates can still have up to 5 refills within 6 months. However, each refill must be dispensed NMT 30 days after the last refill was dispensed.
• No additional refill authorizations may be accepted for an opioid prescription.
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2019 LEGISLATION: CANNABIDIOL (CBD) • Effective 1/1/20, products containing CBD derived from hemp can be legally sold in MN if the following conditions are met: • The product has been tested by an independent, accredited lab to confirm: • Contains the amount of CBD that is stated on label • NMT 0.3% Tetrahydrocannabinol (THC)
• Label contains at a minimum: • • • •
Manufacturer name, contact number, location, website Name and address of accredited lab used to test product Accurate statement of amount of CBD in each unit Statement stating the product does not claim to diagnose, treat, cure, prevent disease and has not been evaluated or approved by the FDA
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MEDICATION DISPOSAL AND RETURNS • Drugs from LTC facilities may be returned to the pharmacy to be re-dispensed if: • 24/7 nurse coverage • Consultant pharmacist/facility can assure proper storage and within a secure area • Meds returned to same pharmacy as dispensed • Integrity of packaging remains intact • No reconstituted; requiring refrigeration; or controlled substances
• Individually wrapped and labeled that indicate drug name, strength, packager’s name, lot number (exp date) Medications can not be returned to the pharmacy for the purpose of disposal/destruction per MN statute.
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MEDICATION DISPOSITION NON-Controlled Substances • Disposed of by administrator or designee and a licensed health care professional • Record kept in client’s permanent record • date, • quantity, • name of drug, • prescription number, • Signatures • To whom medications were given (if applicable) Medications can not be returned to the pharmacy for the purpose of disposal/destruction per MN statute.
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MEDICATION DISPOSITION Controlled Substances • Disposed by: Administrator or designee and a licensed health care professional • Record on Board of Pharmacy Destruction Form (or similar) • https://mn.gov/boards/pharmacy/forms/
• Keep one copy for two years
Medications can not be returned to the pharmacy for the purpose of disposal/destruction per MN statute.
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MEDICATION DISPOSAL (HOW?)
• Means of disposal depends on what type of pharmaceutical waste it is and what type of facility • Household vs. Commercially-Generated • MPCA: Regulatory consensus on Health Care Issues (See page 11) • https://www.pca.state.mn.us/sites/default/files/w-hw3-35.pdf • Pharmaceuticals at residential health care facilities that are stored in centralized, employee-controlled locations separate from resident living areas are considered commercially-generated. • Pharmaceutical waste generated in home-based care facilities with a maximum capacity of six residents may be considered household waste regardless of the above.
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MEDICATION DISPOSAL (HOW?)
Household waste • Mix with unappealing substance – throw in trash • Flush (not best option and not recommended unless an opioid controlled substance) • Take back programs • Drug deactivating systems (e.g. Deterra) • https://deterrasystem.com/
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MEDICATION DISPOSAL (HOW?)
Commercially Generated – next step: • Pharmaceutical waste must be categorized as: 1. Non-Hazardous Waste 2. Hazardous Waste 3. Controlled Substances
The EPA PROHIBITS the sewering of Hazardous waste pharmaceuticals and STRONGLY discourages the sewering of ALL pharmaceuticals. Hazardous Waste Pharmaceuticals (HWPs) – can be difficult to determine - It may be prudent to consider all pharmaceutical waste as hazardous waste pharmaceuticals
Controlled substances that are also Hazardous Waste
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MEDICATION DISPOSAL OPTIONS – COMMERCIAL WASTE Solid Waste - maybe
• Yes-only if evaluated as non-hazardous • (Instance disposal system (Rx Destroyer; Deterra) • Kitty litter or coffee grounds
Hazardous Waste Hauler - yes
• Such as Sharps; Stericycle
Household collection receptacle (at pharmacies & law enforcement) - no
• Not for ‘commercial waste’
Sewering – maybe but strongly discouraged
•
Yes-only if evaluated as non-hazardous •Only to Publicly Owned Treatment Works (POTW) after notification and approval •Not septic system
Pharmacy Receptacle • Designed for LTC facilities yes
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MEDICATION DISPOSAL (CENTRALLY STORED CHCP)
Pharmaceutical Waste (non-hazardous) • HW hauler • Solid Waste • Flush –not recommended
Hazardous Waste
Pharmacy Receptacle covers all three
• HW hauler
Controlled Substance • Solid waste • Flush (only if not Hazardous waste but still not recommended)
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OPERATION WARP SPEED (OWS) • OWS introduced early April 2020 • Promote mass production of multiple vaccines based on preliminary evidence allowing for faster distribution if clinical trials confirm safety and efficacy. • Goal: produce and deliver 300 million doses of safe and effective vaccines with initial doses available by January 2021. • Partnership among components of HHS, including the CDC, FDA, NIH, BARDA (Biomedical Advanced Research and Development Authority), and DoD • April: HHS $483 million supporting Moderna vaccine • May: HHS $1.2 billion supporting AstraZeneca vaccine • July: HS $1.6 billion supporting Novavax vaccine and $1.95 billion suporting Pfizer vaccine • Etc, etc, etc…
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OPERATION WARP SPEED (OWS) – VACCINES Manufacturer
Vaccination schedule
Two step Pfizer/BioNTech vaccine – 21 days apart
Storage
Notes
-80° to -60° C. 5 days under refrigeration (can be replenished with dry ice Q5 days x 30 days); 5 days at 2° to 8°C After dilution: use within 6 hrs
Emergency Use Authorization: granted December 2021
Moderna
Two step vaccine – 28 days apart
-25° to -15°C; 30 days at 2° to 8°C; 12 Emergency Use Authorization: granted hours 8° to 25°C Use within 6 hours once punctured. December 2021
AstraZeneca
Two step – 28 days apart
Approval pending – More “typical” – meaning (i.e., under Already approved in refrigeration) other countries
Johnson & Johnson
Single dose
2 years at -20° C; 90 days at 2° to 8°C (maybe longer)
Approval pending (February) – applied for EUA 2/4/2021
Novavax
Two step vaccine – 21 days apart
More “typical” – ? meaning under refrigeration? Unclear.
Approval pending Q-1 2021
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OPERATION WARP SPEED (OWS) – VACCINES Federal Pharmacy Partnership Program • In MN: included Walgreens, CVS and Thrifty White Pharmacy • Goal: vaccinate LTC facility and staff: 3 clinics each 4 weeks apart • Clinics will be wrapping up in March • What about post clinic ongoing vaccinations?
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VACCINE • Vaccine Side Effects • Pfizer/Moderna vaccines are quite reactogenetic • Injection site pain, fatigue, headache, muscle/joint pain, fever. • More common after the 2nd dose (not always) and in younger adults (not always)
• On rare occasion can produce a anaphylaxis reaction: do not receive if a history of anaphylaxis reaction to other vaccines • C/I: known allergy to PEG or polysorbate or other vaccines or injectables that contain multiple components, one of which is PEG.
• CDC Vaccine information: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinicalconsiderations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfoby-product%2Fpfizer%2Fclinical-considerations.html
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ANTIBODY-BASED THERAPIES • Synthetic versions of proteins made by the immune system • Regeneron Pharmaceuticals • Casirivimab and Imdevimab: Cocktail of two monoclonal antibodies: attempt to block SARS-CoV-2 from infecting cells.
• Eli-Lilly • Bamlanivimab
• Indicated for mild to moderate COVID-19 for those 12 and older. • Not authorized for hospital patients or those requiring oxygen therapy (no benefit) • Difficult to make and expensive • IV infusion – required monitoring during and post infusion.
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OVERALL MEDICATION MANAGEMENT AND COVID-19
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AEROSOL-GENERATING PROCEDURES (AGP) AND COVID-19 • Nebulizers may pose a significant risk of COVID-19 transmission • If inhaled medications are required: favor inhalers over nebulizers • Utilize an aerochamber
• If the patient must receive a nebulizer, staff should: • Limit number of staff; Hand hygiene; Keep door closed • Airborne precautions with N95 mask and eye protection • Clean and disinfect procedure room surfaces and inhaler product promptly
Recommendations from Minnesota Association of Geriatrics Inspired Clinicians.
www.minnesotageriatrics.org/uploads/1/1/8/4/118442543/cpac_covid19_aerosol-generating_procedure_guidelines_pdf.pdf
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REDUCING MEDICATION BURDEN DURING COVID-19 • Respiratory Medications
• Inhalers vs. nebulizers • Transition short acting respiratory agents to long acting agents
• Dietary Supplements
• Continue vitamin/minerals used to treat an active acute deficiency and administer lowest possible dose. • E.g.: Vit D, B12, iron deficiency
• Discontinue all other non-essential herbs/supplements • Glucosamine, fish oil, etc..
• Diabetes
• Eliminate sliding scale • Reassess BID basal insulin
• Allergy Medications
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REDUCING MEDICATION BURDEN DURING COVID-19 • Reduce Routine Medication Monitoring • Vitals with medication administration and hold parameters • Routine blood glucose checks • Routine lab draws
• Consolidating Med-Pass • Streamline/reduce time spent administering meds and time spent in patient room. • Covert medications to daily dosing schedules
• A1C, TSH, BMP, CBC, INR, etc.
• Reevaluate goals of therapy
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QUESTIONS? Joe Litsey, Pharm.D. Board Certified Geriatric Pharmacist Director of Consulting Services - THRIFTY WHITE PHARMACY Jlitsey@thriftywhite.com -- 612-267-0087
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NEW LAWS AFFECTING ASSISTED LIVING March 2, 2021
Jill Schewe, Director of Assisted Living, Housing & Home Care Care Providers of Minnesota, Inc.
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Thank you to our sponsor
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Care Providers of Minnesota Service Corporation, a wholly owned for-profit subsidiary of Care Providers of Minnesota, offers a number of goods and services to Association members. With Service Corporation products you will:
Care Providers of Minnesota
Phone: 952-854-2844 Fax: 952-854-6214 Email: dbeardsley@careproviders.org
7851 Metro Parkway, Suite 200 Bloomington, MN 55425
www.careproviders.org/ServiceCorp
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Housing & Nurse Managers’ Education Series
New Laws Affecting Assisted Living JILL SCHEWE
DIRECTOR OF ASSISTED LIVING, HOUSING & HOME CARE
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INTRODUCTIONS
Jill Schewe, Director of Assisted Living, Housing & Home Care Care Providers of Minnesota, Inc. Jill Schewe has worked in and with assisted living communities her entire career. As a former assisted living manager, her experience was in startup, management, and operations of several assisted living communities. In her current role, Jill works with assisted living providers on any topic they need help with to aid in their success, including: licensing, policy, payment, and operational systems. She understands the needs of older adults and home- and community-based services alike. Jill has a BA in sociology and gerontology from Winona State University and an MA in management from St. Mary’s University of Minnesota.
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Agenda Identify who this new licensure applies to and when
Outline the regulatory requirements
Describe the Assisted Living Director licensure process
CARE PROVIDERS OF MINNESOTA | LEADING MEMBERS TO EXCELLENCE | #CPMEDUCATES
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Housing & Nurse Managers’ Education Series
Assisted Living Licensure
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Who does the new license apply to? All current providers who currently are a registered HWS establishments and either have their own comprehensive home care license or have an arranged agreement with a comprehensive home care license provider and meet the current definition of Assisted Living There are a limited number of settings that are excluded licensure built into the statue such as transitional housing, buildings funded in certain ways, residential settings under 245A, and privately-owned communities such as co-ops But… While there are specific exceptions, the Minnesota Department of Human Services(DHS) has stated that to be “an enrolled provider of customized living services, the setting must obtain an assisted living license”, regardless of whether providers meet the exemption. Handout found here: https://www.careproviders.org/members/2019/ALLicense-DecisionTree.pdf
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Assisted Living Licensure Providers will choose from one of two types of licensure: 1. Assisted Living License, or 2. Assisted Living with Dementia Care License The license essentially combines HWS & Comprehensive Home Care and will cover all services, aspects of unit rental, and physical plant requirements (residents will still have the option to receive services from an outside provider). New licensure fees Assisted Living Facility license fees - $2,000 per building plus $75.00 per resident. Assisted Living Facility with Dementia Care fees - $3,000 per building plus $100.00 per resident
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Assisted Living Licensure If you choose to have an ALL with Dementia Care: Additional requirements are identified for assisted living facilities that advertise, market, or otherwise promote as providing specialized care for individuals with Alzheimer’s disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care. Facilities with this designation must demonstrate the capacity to manage residents with dementia, comply with the additional staffing and staff training requirements, and provide some specific services as needed by each resident.
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ALL Options
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When does it go into effect? The law goes into effect on August 1, 2021. That’s 152 days from today! Yes – we tried really hard to get it delayed because of the COVID-19 pandemic, but we were unsuccessful. All ALs will need to apply for the new license, and all licenses will be effective August 1, 2021 The transitioned facilities will then have staggered renewals to distribute facilities throughout the year. Companies will have the option to stagger their facilities or have them all renew on one date.
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Regulatory Requirements: Statutes vs. Rules We’re used to all our regulations being found in statues (the laws passed the Minnesota legislature) When statues were passed in 2019 for the new Assisted Living Licensure law a handful of areas weren’t fully developed, and the statute outlined a process for some details to be decided through the Rulemaking process (the process by which the legislature gives state agencies, along with stakeholder input, the authority to establish the rules to follow) Going forward we will have two areas to find regulations in: State statue 144G – Assisted Living (NOTE: Sections 144G.01 to 144G.06 are assisted living title protections that are repealed August 1, 2021. Section 144G.07 expires July 31, 2021)
Assisted Living Rules – not finalized yet Handout found here: https://www.careproviders.org/ItemDetail?iProductCode=800217&Category=RESOURCES
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Regulatory Requirements in Statute There are general expectations of all assisted living facilities – the Minimum Assisted Living Facility Requirements include (many are not new) : 1. Distribute the assisted living bill of rights 2.
Providing service in compliance with the Nurse Practice Act
3. Utilize a person-centered planning and service delivery process 4. Have a system for delegation of health care activities to unlicensed personnel by a registered nurse
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Regulatory Requirements in Statute Minimum Assisted Living Facility Requirements include: 5. Provide a means for residents to request assistance for health and safety needs 24 hours per day 6. Allow residents the ability to furnish and decorate the resident's unit within the terms of the assisted living contract 7. Permit resident access to food at any time 8. Allow residents to choose the resident's visitors and times of visits 9. Allow the resident the right to choose a roommate if sharing a unit 10. Notify the resident of the right to have and use a lockable door to the resident's unit
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Regulatory Requirements in Statute Minimum Assisted Living Facility Requirements include: 11. Develop and implement a staffing plan the meets the residents needs
12. Ensuring one or more persons are available 24 hours/day who are awake 13. Offer to provide or make available at least the following services to residents:
At least three nutritious meals and snacks daily Weekly housekeeping and laundry service Direct or reasonable assistance with arranging for transportation Reasonable assistance with accessing community resources Provide culturally sensitive programs Have a daily program of social and recreational activities
14. Provide staff access to an on-call registered nurse 24 hours per day
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Regulatory Requirements in Statute Bill of Rights – will need the new version signed by all Set up meetings with clients/tenants Significant difference from prior version
New Contracts for all residents – will need to be signed by all Two elements in ONE contract Housing (lease/rent) Assisted Living Services (Service Plan)
Consider legal review to comply with new requirements
Survey Cycle – will you be ready? Statues and Rules Every 2-year cycle Building inspection – New!
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Regulatory Requirements in Statute Contract Terminations & Consumer Appeal Rights There are new notice and discharge planning requirements for situations that require a contract termination and a new appeals process with the Office of Administrative Hearings for consumers wishing to contest a contract termination There are separate terms and processes for termination for nonpayment, termination for violations of the contract, and expedited termination where there are health and safety issues involving other residents or facility staff Emergency relocations are allowed with specific notice requirements; however, a facility shall not refuse to allow a resident to return if a termination of housing has not been given
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Regulatory Requirements in Statute Contract Terminations & Consumer Appeal Rights For situations where a facility just decides not to renew a resident’s housing under a contract, there are requirements that the facility either give 60 days’ notice of the nonrenewal and help with relocation planning or follow the termination procedure. Regardless of how a resident is moved from the facility (termination, service reduction, planned closure) there are requirements for facilities to help coordinate the move, including development of a relocation plan that includes a “safe location”.
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Regulatory Requirements in Statute Resident Councils
Family Councils
The facility must provide a resident council with space and privacy for meetings, where doing so is reasonably achievable. Staff, visitors, and other guests may attend a resident council meeting only at the council's invitation.
The facility must provide a family council with space and privacy for meetings, where doing so is reasonably achievable. The facility must designate a staff person who is approved by the family council to be responsible for providing assistance and responding to written requests that result from meetings.
The facility must designate a staff person who is approved by the resident council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the resident council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the resident council, take reasonably achievable steps to make residents aware of upcoming meetings in a timely manner.
The facility must consider the views of the family council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the family council, take reasonably achievable steps to make residents and family members aware of upcoming meetings in a timely manner.
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Regulatory Requirements in Statute Physical plant Existing providers who will transition into licensure will be a legacy provider to most new construction physical plant requirements as long as the physical plant “does not constitute a distinct hazard to life” Any existing elements that surveyors find to be a “distinct hazard to life” must be corrected
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Regulatory Requirements in Statute Despite being a legacy provider, there are some additional physical plant requirements: If not fully sprinkled, smoke detection in each occupied room (tested and maintained) Portable fire extinguishers A maintenance and repair program to keep the physical environment, including walls, floors, ceiling, all furnishings, grounds, systems, and equipment in a continuous state of good repair and operation All-weather roads and walks must be provided within the lot lines to the primary entrance and the service entrance, including employees’ and visitors’ parking at the site Must have space for outdoor activities for residents
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Regulatory Requirements in Statute Other mentionable changes in the new AL requirements : New construction, significant modifications to space, renovations sot space, alternations to space or changes in the use or additions must meet new physical plant requirements There are several provisions related to how to handle resident finances and property, including a requirement to provide a final statement and funds within 30 days of a termination or death The new statue formalizes who a “designated representative” is New closure requirements More outlined areas as to when the Office of Ombudsman for Long Term Care is notified
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Regulatory Requirements in Statute A few notables that stay the same in the new AL requirements: Assessment schedules (within 5, 14, and every 90 day) Residents can still opt out of having any services
Medication assessments Medication and Treatment & Therapy plans Individualized abuse prevention plans Resident and employee records
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Regulatory Requirements in Statute In addition to “regular” assisted living services, dementia care licensees have an additional list of services required to be provided : 1. 2. 3. 4.
ADLs for persons with dementia Non-pharmacological practices that are person-centered and evidence-informed Education of residents and family members about transitions of care and communication Choices for meaningful engagement with other residents and the broader community
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Regulatory Requirements in Statute In addition to “regular” assisted living services, dementia care licensees have an additional list of services required to be provided : Each resident must be evaluated to address the following: 1. 2. 3. 4. 5.
ADLs for persons with dementia Non-pharmacological practices that are person-centered and evidence-informed Education of residents and family members about transitions of care and communication Choices for meaningful engagement with other residents and the broader community Past and current interests
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Regulatory Requirements in Statute In addition to “regular” assisted living services, dementia care licensees have an additional list of services required to be provided : Each resident must be evaluated to address the following: 6. 7. 8. 9. 10.
Current abilities and skills Emotional and Social needs and patterns Physical abilities and limitations Adaptations necessary for resident participation Identification of activities for behavioral interventions
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Regulatory Requirements in Statute In addition to “regular” assisted living services, dementia care licensees have an additional list of services required to be provided : Each resident must be evaluated to address the following: 1. 2.
An individualized activity plan must be developed, reflecting on resident activity preferences and needs A selection of structured and non-structured activities must be available, including… ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦
Occupation or chore related tasks Scheduled and planned events such as entertainment or outings Spontaneous activities for enjoyment or to diffuse a behavior One-to-One activities Spiritual, creative, and intellectual activities Sensory stimulation activities Physical activities that enhance or maintain ambulation and movement Outdoor activities (Brrr)
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Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit): Hazard Vulnerability Assessment completed with hazards mitigated Must be fully sprinkled no later than August 1, 2029 (start planning now) Must meeting NFPA Life Safety Code – Health Care (Limited Care) Chapter Must have an awake staff person at all time physically present in the secured unit Staff must be dementia-trained staff Only staff trained in certain topics are permitted to work with dementia residents Staffing levels must be sufficient, and based on sleep patterns of residents for evening staffing
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Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit): Persons overseeing or providing dementia staff training must have experience and knowledge in the care of individuals with dementia, including: 2 years work experience related to Alzheimer’s disease or related fields Completed training and passed a skills competency or knowledge test required by MDH AL Director must complete at least 10 hours of the required annual training in topics related to the care of residents with dementia
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Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit): Specific policies regarding dementia are required (10 outlined in statue): 1. Philosophy of program 2. Management of behavior and nonpharmacological practices 3. Wander and egress prevention 4. Medication management 5. Staff training specific to dementia care
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Regulatory Requirements in Statute Additional requirements for facilities that elect to have an AL with Dementia Care license (with a secured unit): Specific policies regarding dementia are required continued: 6. Description of life enrichment programs 7. Description of family support programs 8. Limited use of intercoms or paging – for emergencies only 9. Transportation assistance 10. Safekeeping of residents’ possessions
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Regulatory Requirements in Rules Hold on – they’re not done yet! MDH published the draft Rules in December 2020 Public comment period started when the rules were published and ended February 9, 2021 Hearings occurred with an Admistrative Law Judge January 19 and 20, 2021 A rebuttal period started February 10 and ended February 17, 2021 Currently waiting on the Administrative Law Judge to decide on final requirements (she has 30 days from the end of the rebuttal period). As part of the process: Care Providers of Minnesota submitted comments, testified, and submitted rebuttal comments
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Regulatory Requirements in Rules Elements of what’s in the proposed Rule: Resident assessment/reassessments - your initial assessment is CRITICAL Must be conducted on prospective residents Each facility must develop, but must contain minimum identified elements (and there are a lot of them) Must be able to conduct a nursing assessment on weekends if resident is returning from the hospital Every 90 days, and changes in condition Also adds “Individualized Review” for non-AL services (RN need not complete)
Uniform checklist disclosure of services (MDH to post sample) Facility to submit their version to MDH at application and each renewal, and each time updated
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Regulatory Requirements in Rules Elements of what’s in the proposed Rule: Contract terminations and Discharge Planning Emergency Preparedness Plan – CMS Appendix Z (ouch) Missing Resident Plan Staffing – No ratios (that goodness). Must have a plan, developed by RN. Must post staffing for the public to see. Staffing must meet the needs of residents. Two staff must be on duty at all times if any resident requires the assistance of two for scheduled and unscheduled needs. Call lights must be answered within 10 minutes during evening hours
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Next steps & what you can do Read the statute and proposed rules to identify what areas or concepts in your current operation will need to change. Who/What will hold the AL license What license will you apply for (regular or memory care?) Who will be the LALD? Who will be the Clinical Nurse Supervisor? How and when will you update your contracts to comply with the new requirements? How and when will you update your uniform assessment tool and disclosure to comply? Updates to policies and procedures
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Housing & Nurse Managers’ Education Series
Licensed Assisted Living Director
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Who does the LALD apply to? All licensed assisted living facilities will have to have a Licensed Assisted Living Director (LALD or ALD) This person is responsible for the general administration and management of the facility and oversee the day-to-day operations, including: Ensure that services and support are provided in a manner to protect health, safety and well-being, and consistent with residents’ rights, including the right to refuse services Ensure facility is in compliance with all applicable laws and regulations Ensure all required policies, procedures and services are in place Ensure the building and grounds are well maintained Ensure proper recruitment, hiring, training and supervision of staff
You will apply for an ALD licenses through the Minnesota Board of Executives for Long Term Services and Supports (BELTSS)
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Routes to become a LALD OPTION 1 (CURRENTLY UNDER DEVELOPMENT) Has completed an approved training course and passed an examination approved by the Board of Executives for Long Term Services and Supports that is designed to test for competence and that includes assisted living facility laws in Minnesota
OPTION 2 (PARTIALLY UNDER DEVELOPMENT) Is a Licensed Nursing Home Administrator or has been validated as a Qualified Health Services Executive by the National Association of Long-Term Care Administrator Boards (NAB) and has a core knowledge of Minnesota Assisted Living laws (how to define and measure core knowledge is still to be determined)
Handout found here: https://www.careproviders.org/members/2019/ALDirector-DecisionTreev2.pdf
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Routes to become a LALD OPTION 3 – LEGACY OPTIONS 1. Has a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance
2. Has completed at least 1,000 hours of a director/executive in training program provided by a licensed assisted living director
3. Has managed a registered housing with services establishment under assisted living title protection for at least three years
4. Has at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility
Handout found here: https://www.careproviders.org/members/2019/ALDirector-DecisionTreev2.pdf
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Assisted Living Director How do I get a license if I meet a legacy in option?
• Complete an application (goal to be all online) • Identify one of the requirements to be a legacy • Application will most likely have an attestation you sign that you’ve met the • •
requirements You will submit a resume or like document to show your experience You will submit education transcripts that you’ll have sent directly to BELTSS
• Complete a background check (different from the NetStudy 2.0 study) • Paid a licensing fee (talk has been around $250)
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Assisted Living Director in Residence What if I don’t meet the criteria for a legacy license?
• Don’t panic – you’re NOT necessarily out of a job! • You will apply with BELTSS to be an Assisted Living Director in Residence (ALDIR) within 30 days of the process being open
• Complete a background check (different from the NetStudy 2.0 study) • Paid a licensing fee (talk has been around $250) • You will have 1 year to complete the required elements of licensure (course work, field experience & test)
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Assisted Living Director in Residence What if I don’t meet the criteria for a legacy license?
• You must meet one of the following education and work experience requirements: • A high school diploma or equivalent +2 years of work experience in the continuum of LTC, including 1 year in a management or supervisory position, or
•
An Associate’s degree + 6 months of work experience in a management or supervisory position; or
•
A Bachelor’s degree + 6 months work experience in a management or supervisory experience in LTC
• You will need to have a mentor, who is a licensed AL director, oversee you. This person can be anyone who is licensed
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Assisted Living Director in Residence After you’ve received an ALDIR permit – within 1 year you must:
• You will complete a self assessment which will help determine the number of hours you will need to complete (the proposed rule is 320-1000 hours)
• Compete field experience hours under the direction of your mentor • Compete the required course work (still under development) • Pass the required test(s) for licensure (still under development) • Then you will receive your ALD license!!
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Assisted Living Director Once you are licensed – then what?
• You need to obtain 7 continuing education hours
within the first year of licensure • Unlike the HWS education requirements, these continuing education credits will need to be approved / accredited
• Licenses will be renewed annually (likely in the fall when LNHA are) • An annual renewal fee will be collected (talk is around $250)
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Assisted Living Director Once you are licensed – then what?
• You must have at least 30 hours of training every two years on topics relevant to the operation of a licensed Assisted Living facility and the needs of the residents.
• If you are managing a licensed Assisted Living with Dementia Care, you must complete and document that at least 10 hours of the required 30 hours of training relate to the care of individuals with dementia. (again, all education, once licensed, needs to be CEU accredited education)
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Assisted Living Director Can I oversee more than 1 licensed assisted living setting?
• Yes, you can apply to over see more than one settings if: • You have a license in good standing • You are overseeing more than 5 settings within a 60-mile radius • Each setting has a common management • If you want to apply to over see buildings outside those parameters, you will apply to the board to do so and they will determine approval
• You must maintain sufficient on-site presence to effectively be the director, manage and supervise each facility
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Board of Examiners for Long Term Services and Supports (BELTSS) As a licensed professional – you have new responsibilities!
• You need to follow any direction from BELTSS and communicate with them as required
• There are Code of Ethics expectations (like all other professional licenses) • The BELTSS board has disciplinary actions for failing to uphold the integrity of your license
• There is a complaint process to the board for licensed professional
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Board of Examiners for Long Term Services and Supports (BELTSS) Other things to note:
• BELTSS is made up of a volunteer board of directors – currently all licensed nursing home administrators. The new statue adds and Assisted Living Director and an Assisted Living nurse slots to the board's makeup
• You can find more information on the BELTSS website: https://mn.gov/boards/nursing-home/applicants/assisted-living-director/
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When LALD go into effect and what are we waiting for? When does it go into effect? •ALD Licensure goes into effect with “sunrise” of AL licensure on August 1, 2021 •Those eligible to be a legacy ALD’s will need to apply for licensure by July 1, 2021
What are we waiting for? •The BELTSS board is working on: • The application process for legacy licensees • The application process to apply for an ALDIR permit • The process for new applications (not legacy) • Work with educators to approve education content that is accredited for licensure
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Next steps & what you can do There’s not much you can do right now … Wait to hear how legacy providers will apply for licensure and the more specific details of who’s eligible and who’s not If you won’t qualify for a ALD license, and you’re currently the director, watch for next steps to apply for an ALDIR Update your resume or like document – you’ll need it when applying Round up who and how you request your transcripts from your education institutions – but don’t’ request them yet, until we know where you will have to have them sent to Hang tight!
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What CPM is working on to help you prepare? Watch for lots of education to come in the next 6 months! We’re working on monthly Assisted Living webinars on various consolidated topics The Assisted Living Summit is being planned for dates TBD in May We are in the process of writing all new resource manuals for you Plus, as always, we’re here to answer your individual calls and emails Watch your weekly ACTION newsletter for details as they come out!
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Questions JILL SCHEWE Director of Assisted Living, Housing & Home Care Care Providers of Minnesota jschewe@careproviders.org (952) 851-2484
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Do I need an Assisted Living Facility License or an Assisted Living Facility with Dementia Care License? YES
NO
Are you a facility that provides sleeping accommodations to one or more adults
Are you any of the following? An emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals (see 116L.361) A nursing home (144A), or a hospital , boarding care home, or licensed supervised living facility (144.50-144.56) A licensed lodging establishment Residential settings licensed under 245A, or adult foster care (245D) A private home in which the residents are related by kinship, law, or affinity with the providers of services A duly organized condominium, cooperative, or common interest community where at least 80% of the units are owners, members, or shareholders of the units A temporary family health care dwelling (394.307 & 426.3593) A setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing Housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services Rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q Rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56 Rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011
NO
You are not required to have an AL License
YES
Do you provide one or more of the following Assistance with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing Standby assistance Verbal or visual reminders to residents to take regularly scheduled medication(s), which includes bring the resident previously set-up medication(s), medication(s) in original containers, or liquid or food to accompany the medication(s) Verbal or visual reminders to the resident to perform regularly scheduled treatments and/or exercises The preparation of modified diets ordered by a licensed health professional The services of an advanced practice registered nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker Tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person’s scope of practice Medication management services Hands-on assistance with transfers and mobility Treatments and therapies Assistance for residents with eating when the residents have complicated eating problems Complex or specialty health care services
YES You need an AL
NO
license
Does either of the following apply to your facility? You are required to have an Assisted Living Facility with Dementia Care license
You advertise, market, or otherwise promote yourself an assisted living as providing specialized care for dementia or related disorders.
YES
You have a secured dementia care unit, meaning a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident’s ability to exit, the secured area or setting.
NO
You are required to have an Assisted Living Facility License. You have the option to have an Assisted Living Facility with Dementia Care license.
© Care Providers of Minnesota 5/19 1.3
Assisted Living Director Licensure By August 1, 2021, each Licensed Assisted Living Facility in Minnesota must be managed by a Licensed Assisted Living Director. There are three “routes” available to become a Licensed Assisted Living Director:
OPTION 1 (to be developed)
Has completed an approved training course and passed an examination approved by the Board of Executives for Long Term Services and Supports (formally BENHA) that is designed to test for competence and that includes assisted living facility laws in Minnesota
OPTION 2
Is a Licensed Nursing Home Administrator or has been validated as a Qualified Health Services Executive by the National Association of LongTerm Care Administrator Boards (NAB) and has a core knowledge of Minnesota Assisted Living laws (how to define and measure core knowledge is still to be determined)
OPTION 3
(“legacy” options)
Apply for licensure by July 1, 2021 AND satisfy at least ONE of the following requirements
Has a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance
Has completed at least 1,000 hours of a director/ executive in training program provided by a licensed assisted living director
Has managed a registered housing with services establishment under assisted living title protection for at least three years
Has at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility
Assisted Living Director licenses will be managed by the Minnesota Board of Executives for Long Term Services and Supports (formerly the Board of Examiners for Nursing Home Administrators/BENHA). Each Licensed Assisted Living Director must receive at least 30 hours of training every two years on topics relevant to the operation of a Licensed Assisted Living Facility and the needs to its residents. If the Licensed Assisted Living Director is managing a Licensed Assisted Living with Dementia Care, the Director must complete and document that at least 10 hours of the required 30 hours of training relate to the care of individuals with dementia. Care Providers of Minnesota 8/19
Compliance with Minnesota’s §325F.721 “I’m okay” Check Services Statue Are you an unlicensed setting providing sleeping accommodations to one or more adult residents, at least 80% which are 55 years of age or older
YES
NO
Do you, for a fee, offer any of the following supportive services? Assistance with laundry Assistance with shopping Assistance with household chores Housekeeping services Provision or assistance with meals or food preparation Help with arranging for, on arranging transportation to, medical, social, recreational, personal, or social services appointments Provision of social or recreational services
YES
The “I’m okay” statute does not apply to you.
NO
Are you any of the following? Emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals (see 116L.361) A nursing home A hospital A certified boarding care home A licensed supervised living facility A licensed lodging establishment Residential settings licensed under 245A Adult foster care An assisted living facility licensed under chapter 144I A setting governed by the standards of 245D A private home in which the residents are related by kinship, law, or affinity with the providers of services A duly organized condominium, cooperative, or common interest community where at least 80% of the units are owners, members, or shareholders of the units A temporary family health care dwelling (394.307 & 426.3593) A setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing Housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services Rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q Rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56 Rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011
The “I’m okay” statute does not apply to you.
YES
NO
Effective with contracts entered into on or after August 21, 2021, you must comply with the following three requirements:
You must disclose to prospective residents that the facility is not licensed as an assisted living facility under chapter 144I and, notwithstanding any contract for "I'm okay" check services, is not permitted to provide assisted living services, as defined in section 144I.01, subdivision 9, either directly or through a provider under a business relationship or other affiliation with the covered setting. You must prominently disclose in a written contract whether or not your setting itself or through a provider with which the your setting has a business agreement offers "I'm okay" check services. If the resident contracts for "I'm okay" check services, the written contract must detail the nature, extent, and frequency of the provision of these services. © Care Providers of Minnesota 5/19
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CHAPTER 144G ASSISTED LIVING NOTE: Sections 144G.01 to 144G.06 are assisted living title protections that are repealed August 1, 2021. Section 144G.07 expires July 31, 2021. 144G.01
DEFINITIONS.
144G.51
ARBITRATION.
144G.02
ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION.
144G.52
ASSISTED LIVING CONTRACT TERMINATIONS.
144G.53
NONRENEWAL OF HOUSING.
144G.54
APPEALS OF CONTRACT TERMINATIONS.
144G.55
COORDINATED MOVES.
144G.03
ASSISTED LIVING REQUIREMENTS.
144G.04
RESERVATION OF RIGHTS.
144G.05
REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES.
144G.56
TRANSFER OF RESIDENTS WITHIN FACILITY.
144G.06
UNIFORM CONSUMER INFORMATION GUIDE.
144G.57
PLANNED CLOSURES.
144G.07
RETALIATION PROHIBITED. 144G.60
STAFFING REQUIREMENTS.
STAFFING REQUIREMENTS
ASSISTED LIVING LICENSURE 144G.08
DEFINITIONS.
144G.61
STAFF COMPETENCY EVALUATIONS.
144G.09
COMMISSIONER OVERSIGHT AND AUTHORITY OVER ASSISTED LIVING FACILITIES.
144G.62
DELEGATION AND SUPERVISION.
144G.63
ORIENTATION AND ANNUAL TRAINING REQUIREMENTS.
144G.64
TRAINING IN DEMENTIA CARE REQUIRED.
144G.70
SERVICES.
144G.71
MEDICATION MANAGEMENT.
144G.72
TREATMENT AND THERAPY MANAGEMENT SERVICES.
144G.10
ASSISTED LIVING FACILITY LICENSE.
144G.11
APPLICABILITY OF OTHER LAWS.
144G.12
APPLICATION FOR LICENSURE.
144G.13
BACKGROUND STUDIES OF LICENSE APPLICANTS.
144G.15
CONSIDERATION OF APPLICATIONS.
144G.16
PROVISIONAL LICENSE.
144G.17
LICENSE RENEWAL.
144G.18
NOTIFICATION OF CHANGES IN INFORMATION.
144G.19
TRANSFER OF LICENSE PROHIBITED.
SERVICES
ASSISTED LIVING FACILITIES WITH DEMENTIA CARE 144G.80
ADDITIONAL LICENSING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.
144G.81
ADDITIONAL REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH SECURED DEMENTIA CARE UNITS.
144G.82
ADDITIONAL RESPONSIBILITIES OF ADMINISTRATION FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.
144G.83
ADDITIONAL TRAINING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.
144G.84
SERVICES FOR RESIDENTS WITH DEMENTIA.
ENFORCEMENT 144G.20
ENFORCEMENT.
SURVEYS, CORRECTION ORDERS, AND FINES 144G.30
SURVEYS AND INVESTIGATIONS.
144G.31
VIOLATIONS AND FINES.
144G.32
RECONSIDERATION OF CORRECTION ORDERS AND FINES.
144G.33
INNOVATION VARIANCE.
OPERATIONS AND PHYSICAL PLANT REQUIREMENTS 144G.40
HOUSING AND SERVICES.
144G.401
PAYMENT FOR SERVICES UNDER DISABILITY WAIVERS.
RESIDENT RIGHTS AND PROTECTIONS 144G.90
REQUIRED NOTICES.
144G.91
ASSISTED LIVING BILL OF RIGHTS.
144G.911
RESTRICTIONS UNDER HOME AND COMMUNITY-BASED WAIVERS.
144G.41
MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS.
144G.42
BUSINESS OPERATION.
144G.43
RESIDENT RECORD REQUIREMENTS.
144G.92
RETALIATION PROHIBITED.
MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS.
144G.93
CONSUMER ADVOCACY AND LEGAL SERVICES.
144G.95
OFFICE OF OMBUDSMAN FOR LONG-TERM CARE.
144G.9999
RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT TASK FORCE.
144G.45
CONTRACTS, TERMINATIONS, AND RELOCATIONS 144G.50
ASSISTED LIVING CONTRACT REQUIREMENTS.
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144G.01 DEFINITIONS. Subdivision 1. Scope; other definitions. For purposes of sections 144G.01 to 144G.05, the following definitions apply. In addition, the definitions provided in section 144D.01 also apply to sections 144G.01 to 144G.05. Subd. 2. Assisted living. "Assisted living" means a service or package of services advertised, marketed, or otherwise described, offered, or promoted using the phrase "assisted living" either alone or in combination with other words, whether orally or in writing, and which is subject to the requirements of this chapter. Subd. 3. Assisted living client; client. "Assisted living client" or "client" means a housing with services resident who receives assisted living that is subject to the requirements of this chapter. Subd. 4. Commissioner. "Commissioner" means the commissioner of health. History: 2006 c 282 art 19 s 13; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.02 ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION. Subdivision 1. Protected title; restriction on use. No person or entity may use the phrase "assisted living," whether alone or in combination with other words and whether orally or in writing, to advertise, market, or otherwise describe, offer, or promote itself, or any housing, service, service package, or program that it provides within this state, unless the person or entity is a housing with services establishment that meets the requirements of this chapter, or is a person or entity that provides some or all components of assisted living that meet the requirements of this chapter. A person or entity entitled to use the phrase "assisted living" shall use the phrase only in the context of its participation in assisted living that meets the requirements of this chapter. A housing with services establishment offering or providing assisted living that is not made available to residents in all of its housing units shall identify the number or location of the units in which assisted living is available, and may not use the term "assisted living" in the name of the establishment registered with the commissioner under chapter 144D, or in the name the establishment uses to identify itself to residents or the public. Subd. 2. Authority of commissioner. (a) The commissioner, upon receipt of information that may indicate the failure of a housing with services establishment, the arranged home care provider, an assisted living client, or an assisted living client's representative to comply with a legal requirement to which one or more of the entities may be subject, shall make appropriate referrals to other governmental agencies and entities having jurisdiction over the subject matter. The commissioner may also make referrals to any public or private agency the commissioner considers available for appropriate assistance to those involved. (b) In addition to the authority with respect to licensed home care providers under section 144A.45 and with respect to housing with services establishments under chapter 144D, the commissioner shall have standing to bring an action for injunctive relief in the district court in the district in which a housing with services establishment is located to compel the housing with services establishment or the arranged home care provider to meet the requirements of this chapter or other requirements of the state or of any county or local governmental unit to which the establishment or arranged home care provider is otherwise subject. Proceedings for securing an injunction may be brought by the commissioner through the attorney general
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or through the appropriate county attorney. The sanctions in this section do not restrict the availability of other sanctions. History: 2006 c 282 art 19 s 14; 2013 c 108 art 11 s 33; 2014 c 275 art 1 s 134,138; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.03 ASSISTED LIVING REQUIREMENTS. Subdivision 1. Verification in annual registration. A registered housing with services establishment using the phrase "assisted living," pursuant to section 144G.02, subdivision 1, shall verify to the commissioner in its annual registration pursuant to chapter 144D that the establishment is complying with sections 144G.01 to 144G.05, as applicable. Subd. 2. Minimum requirements for assisted living. (a) Assisted living shall be provided or made available only to individuals residing in a registered housing with services establishment. Except as expressly stated in this chapter, a person or entity offering assisted living may define the available services and may offer assisted living to all or some of the residents of a housing with services establishment. The services that comprise assisted living may be provided or made available directly by a housing with services establishment or by persons or entities with which the housing with services establishment has made arrangements. (b) A person or entity entitled to use the phrase "assisted living," according to section 144G.02, subdivision 1, shall do so only with respect to a housing with services establishment, or a service, service package, or program available within a housing with services establishment that, at a minimum: (1) provides or makes available health-related services under a home care license. At a minimum, health-related services must include: (i) assistance with self-administration of medication, medication management, or medication administration as defined in section 144A.43; and (ii) assistance with at least three of the following seven activities of daily living: bathing, dressing, grooming, eating, transferring, continence care, and toileting. All health-related services shall be provided in a manner that complies with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (2) provides necessary assessments of the physical and cognitive needs of assisted living clients by a registered nurse, as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (3) has and maintains a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (4) provides staff access to an on-call registered nurse 24 hours per day, seven days per week; (5) has and maintains a system to check on each assisted living client at least daily;
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(6) provides a means for assisted living clients to request assistance for health and safety needs 24 hours per day, seven days per week, from the establishment or a person or entity with which the establishment has made arrangements; (7) has a person or persons available 24 hours per day, seven days per week, who is responsible for responding to the requests of assisted living clients for assistance with health or safety needs, who shall be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the housing with services establishment in order to respond within a reasonable amount of time; (iii) capable of communicating with assisted living clients; (iv) capable of recognizing the need for assistance; (v) capable of providing either the assistance required or summoning the appropriate assistance; and (vi) capable of following directions; (8) offers to provide or make available at least the following supportive services to assisted living clients: (i) two meals per day; (ii) weekly housekeeping; (iii) weekly laundry service; (iv) upon the request of the client, reasonable assistance with arranging for transportation to medical and social services appointments, and the name of or other identifying information about the person or persons responsible for providing this assistance; (v) upon the request of the client, reasonable assistance with accessing community resources and social services available in the community, and the name of or other identifying information about the person or persons responsible for providing this assistance; and (vi) periodic opportunities for socialization; and (9) makes available to all prospective and current assisted living clients information consistent with the uniform format and the required components adopted by the commissioner under section 144G.06. This information must be made available beginning no later than six months after the commissioner makes the uniform format and required components available to providers according to section 144G.06. Subd. 3. Exemption from awake-staff requirement. A housing with services establishment that offers or provides assisted living is exempt from the requirement in subdivision 2, paragraph (b), clause (7), item (i), that the person or persons available and responsible for responding to requests for assistance must be awake, if the establishment meets the following requirements: (1) the establishment has a maximum capacity to serve 12 or fewer assisted living clients; (2) the person or persons available and responsible for responding to requests for assistance are physically present within the housing with services establishment in which the assisted living clients reside; (3) the establishment has a system in place that is compatible with the health, safety, and welfare of the establishment's assisted living clients;
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(4) the establishment's housing with services contract, as required by section 144D.04, includes a statement disclosing the establishment's qualification for, and intention to rely upon, this exemption; (5) the establishment files with the commissioner, for purposes of public information but not review or approval by the commissioner, a statement describing how the establishment meets the conditions in clauses (1) to (4), and makes a copy of this statement available to actual and prospective assisted living clients; and (6) the establishment indicates on its housing with services registration, under section 144D.02 or 144D.03, as applicable, that it qualifies for and intends to rely upon the exemption under this subdivision. Subd. 4. Nursing assessment. (a) A housing with services establishment offering or providing assisted living shall: (1) offer to have the arranged home care provider conduct a nursing assessment by a registered nurse of the physical and cognitive needs of the prospective resident and propose a service plan prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier; and (2) inform the prospective resident of the availability of and contact information for long-term care consultation services under section 256B.0911, prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier. (b) An arranged home care provider is not obligated to conduct a nursing assessment by a registered nurse when requested by a prospective resident if either the geographic distance between the prospective resident and the provider, or urgent or unexpected circumstances, do not permit the assessment to be conducted prior to the date on which the prospective resident executes a contract or moves in, whichever is earlier. When such circumstances occur, the arranged home care provider shall offer to conduct a telephone conference whenever reasonably possible. (c) The arranged home care provider shall comply with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285, with respect to the provision of a nursing assessment prior to the delivery of nursing services and the execution of a home care service plan or service agreement. Subd. 5. Assistance with arranged home care provider. The housing with services establishment shall provide each assisted living client with identifying information about a person or persons reasonably available to assist the client with concerns the client may have with respect to the services provided by the arranged home care provider. The establishment shall keep each assisted living client reasonably informed of any changes in the personnel referenced in this subdivision. Upon request of the assisted living client, such personnel or designee shall provide reasonable assistance to the assisted living client in addressing concerns regarding services provided by the arranged home care provider. Subd. 6. Termination of housing with services contract. If a housing with services establishment terminates a housing with services contract with an assisted living client, the establishment shall provide the assisted living client, and the legal or designated representative of the assisted living client, if any, with a written notice of termination which includes the following information: (1) the effective date of termination; (2) the section of the contract that authorizes the termination;
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(3) without extending the termination notice period, an affirmative offer to meet with the assisted living client and, if applicable, client representatives, within no more than five business days of the date of the termination notice to discuss the termination; (4) an explanation that: (i) the assisted living client must vacate the apartment, along with all personal possessions, on or before the effective date of termination; (ii) failure to vacate the apartment by the date of termination may result in the filing of an eviction action in court by the establishment, and that the assisted living client may present a defense, if any, to the court at that time; and (iii) the assisted living client may seek legal counsel in connection with the notice of termination; (5) a statement that, with respect to the notice of termination, reasonable accommodation is available for the disability of the assisted living client, if any; and (6) the name and contact information of the representative of the establishment with whom the assisted living client or client representatives may discuss the notice of termination. History: 2006 c 282 art 19 s 15; 2016 c 179 s 17,18; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.04 RESERVATION OF RIGHTS. Subdivision 1. Use of services. Nothing in this chapter requires an assisted living client to utilize any service provided or made available in assisted living. Subd. 2. Housing with services contracts. Nothing in this chapter requires a housing with services establishment to execute or refrain from terminating a housing with services contract with a prospective or current resident who is unable or unwilling to meet the requirements of residency, with or without assistance. Subd. 3. Provision of services. Nothing in this chapter requires the arranged home care provider to offer or continue to provide services under a service agreement or service plan to a prospective or current resident of the establishment whose needs cannot be met by the arranged home care provider. Subd. 4. Altering operations; service packages. Nothing in this chapter requires a housing with services establishment or arranged home care provider offering assisted living to fundamentally alter the nature of the operations of the establishment or the provider in order to accommodate the request or need for facilities or services by any assisted living client, or to refrain from requiring, as a condition of residency, that an assisted living client pay for a package of assisted living services even if the client does not choose to utilize all or some of the services in the package. History: 2006 c 282 art 19 s 16; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.
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144G.05 REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES. Notwithstanding the provisions of this chapter, the requirements for the elderly waiver program's assisted living payment rates under sections 256S.201 and 256S.202 shall continue to be effective and providers who do not meet the requirements of this chapter may continue to receive payment under sections 256S.201 and 256S.202, as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved Elderly Home and Community Based Services Waiver Program (Control Number 0025.91). Providers of assisted living for the community access for disability inclusion (CADI) and Brain Injury (BI) waivers shall continue to receive payment as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved CADI and BI waiver plans. History: 2006 c 282 art 19 s 17; 2012 c 216 art 14 s 2; 2015 c 78 art 6 s 31; 2019 c 54 art 2 s 4; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.06 UNIFORM CONSUMER INFORMATION GUIDE. The commissioner shall adopt a uniform format for the guide to be used by individual providers, and the required components of materials to be used by providers to inform assisted living clients of their legal rights, and shall make the uniform format and the required components available to assisted living providers. History: 2006 c 282 art 19 s 18; 1Sp2010 c 1 art 17 s 5; 2014 c 286 art 7 s 3; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.07 RETALIATION PROHIBITED. Subdivision 1. Definitions. For the purposes of this section: (1) "facility" means a housing with services establishment registered under section 144D.02 and operating under title protection under sections 144G.01 to 144G.07; and (2) "resident" means a resident of a facility. Subd. 2. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the administrator or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law;
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(6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or (9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 3. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; (7) an arbitrary increase in charges or fees; (8) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices; or (9) any oral or written communication of false information about a person advocating on behalf of the resident. Subd. 4. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination.
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Subd. 5. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 3 within 30 days of an initial action described in subdivision 2, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred. History: 2019 c 60 art 3 s 3 NOTE: This section, as added by Laws 2019, chapter 60, article 3, section 3, expires July 31, 2021. Laws 2019, chapter 60, article 3, section 3, the effective date. ASSISTED LIVING LICENSURE 144G.08 DEFINITIONS. Subdivision 1. Applicability. For the purposes of this chapter, the terms in this section have the meanings given. Subd. 2. Adult. "Adult" means a natural person who has attained the age of 18 years. Subd. 3. Advanced practice registered nurse. "Advanced practice registered nurse" has the meaning given in section 148.171, subdivision 3. Subd. 4. Applicant. "Applicant" means an individual, legal entity, or other organization that has applied for licensure under this chapter. Subd. 5. Assisted living contract. "Assisted living contract" means the legal agreement between a resident and an assisted living facility for housing and, if applicable, assisted living services. Subd. 6. Assisted living director. "Assisted living director" means a person who administers, manages, supervises, or is in general administrative charge of an assisted living facility, whether or not the individual has an ownership interest in the facility, and whether or not the person's functions or duties are shared with one or more individuals and who is licensed by the Board of Executives for Long Term Services and Supports pursuant to section 144A.20. Subd. 7. Assisted living facility. "Assisted living facility" means a licensed facility that provides sleeping accommodations and assisted living services to one or more adults. Assisted living facility includes assisted living facility with dementia care, and does not include: (1) emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals, as defined under section 116L.361; (2) a nursing home licensed under chapter 144A; (3) a hospital, certified boarding care, or supervised living facility licensed under sections 144.50 to 144.56; (4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, or under chapter 245D or 245G; (5) services and residential settings licensed under chapter 245A, including adult foster care and services and settings governed under the standards in chapter 245D;
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(6) a private home in which the residents are related by kinship, law, or affinity with the provider of services; (7) a duly organized condominium, cooperative, and common interest community, or owners' association of the condominium, cooperative, and common interest community where at least 80 percent of the units that comprise the condominium, cooperative, or common interest community are occupied by individuals who are the owners, members, or shareholders of the units; (8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593; (9) a setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing; (10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services; (11) rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q; (12) rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56; (13) rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011; or (14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b). Subd. 8. Assisted living facility with dementia care. "Assisted living facility with dementia care" means a licensed assisted living facility that is advertised, marketed, or otherwise promoted as providing specialized care for individuals with Alzheimer's disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care. Subd. 9. Assisted living services. "Assisted living services" includes one or more of the following: (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing; (2) providing standby assistance; (3) providing verbal or visual reminders to the resident to take regularly scheduled medication, which includes bringing the resident previously set up medication, medication in original containers, or liquid or food to accompany the medication; (4) providing verbal or visual reminders to the resident to perform regularly scheduled treatments and exercises; (5) preparing modified diets ordered by a licensed health professional; (6) services of an advanced practice registered nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker;
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(7) tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person's scope of practice; (8) medication management services; (9) hands-on assistance with transfers and mobility; (10) treatment and therapies; (11) assisting residents with eating when the residents have complicated eating problems as identified in the resident record or through an assessment such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be fed; (12) providing other complex or specialty health care services; and (13) supportive services in addition to the provision of at least one of the services listed in clauses (1) to (12). Subd. 10. Authority having jurisdiction. "Authority having jurisdiction" means an organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure. Subd. 11. Authorized agent. "Authorized agent" means the person who is authorized to accept service of notices and orders on behalf of the licensee. Subd. 12. Change of ownership. "Change of ownership" means a change in the licensee that is responsible for the management, control, and operation of a facility. Subd. 13. Commissioner. "Commissioner" means the commissioner of health. Subd. 14. Controlled substance. "Controlled substance" has the meaning given in section 152.01, subdivision 4. Subd. 15. Controlling individual. (a) "Controlling individual" means an owner and the following individuals and entities, if applicable: (1) each officer of the organization, including the chief executive officer and chief financial officer; (2) each managerial official; and (3) any entity with at least a five percent mortgage, deed of trust, or other security interest in the facility. (b) Controlling individual does not include: (1) a bank, savings bank, trust company, savings association, credit union, industrial loan and thrift company, investment banking firm, or insurance company unless the entity operates a program directly or through a subsidiary; (2) government and government-sponsored entities such as the U.S. Department of Housing and Urban Development, Ginnie Mae, Fannie Mae, Freddie Mac, and the Minnesota Housing Finance Agency which provide loans, financing, and insurance products for housing sites; (3) an individual who is a state or federal official, a state or federal employee, or a member or employee of the governing body of a political subdivision of the state or federal government that operates one or more
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facilities, unless the individual is also an officer, owner, or managerial official of the facility, receives remuneration from the facility, or owns any of the beneficial interests not excluded in this subdivision; (4) an individual who owns less than five percent of the outstanding common shares of a corporation: (i) whose securities are exempt under section 80A.45, clause (6); or (ii) whose transactions are exempt under section 80A.46, clause (2); (5) an individual who is a member of an organization exempt from taxation under section 290.05, unless the individual is also an officer, owner, or managerial official of the license or owns any of the beneficial interests not excluded in this subdivision. This clause does not exclude from the definition of controlling individual an organization that is exempt from taxation; or (6) an employee stock ownership plan trust, or a participant or board member of an employee stock ownership plan, unless the participant or board member is a controlling individual. Subd. 16. Dementia. "Dementia" means the loss of cognitive function, including the ability to think, remember, problem solve, or reason, of sufficient severity to interfere with an individual's daily functioning. Dementia is caused by different diseases and conditions, including but not limited to Alzheimer's disease, vascular dementia, neurodegenerative conditions, Creutzfeldt-Jakob disease, and Huntington's disease. Subd. 17. Dementia care services. "Dementia care services" means ongoing care for behavioral and psychological symptoms of dementia, including planned group and individual programming and person-centered care practices provided according to section 144G.84 to support activities of daily living for people living with dementia. Subd. 18. Dementia-trained staff. "Dementia-trained staff" means any employee who has completed the minimum training required under sections 144G.64 and 144G.83 and has demonstrated knowledge and the ability to support individuals with dementia. Subd. 19. Designated representative. "Designated representative" means a person designated under section 144G.50. Subd. 20. Dietary supplement. "Dietary supplement" means a product taken by mouth that contains a dietary ingredient intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissue, glandulars, or metabolites. Subd. 21. Dietitian. "Dietitian" means a person licensed as a dietitian under section 148.624. Subd. 22. Direct contact. "Direct contact" means providing face-to-face care, training, supervision, counseling, consultation, or medication assistance to residents of a facility. Subd. 23. Direct ownership interest. "Direct ownership interest" means an individual or organization with the possession of at least five percent equity in capital, stock, or profits of the licensee, or who is a member of a limited liability company of the licensee. Subd. 24. Facility. "Facility" means an assisted living facility. Subd. 25. Hands-on assistance. "Hands-on assistance" means physical help by another person without which the resident is not able to perform the activity.
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Subd. 26. "I'm okay" check services. "'I'm okay' check services" means having, maintaining, and documenting a system to, by any means, check on the safety of a resident a minimum of once daily or more frequently according to the assisted living contract. Subd. 27. Indirect ownership interest. "Indirect ownership interest" means an individual or legal entity with a direct ownership interest in an entity that has a direct or indirect ownership interest of at least five percent in an entity that is a licensee. Subd. 28. Legal representative. "Legal representative" means one of the following in the order of priority listed, to the extent the person may reasonably be identified and located: (1) a court-appointed guardian acting in accordance with the powers granted to the guardian under chapter 524; (2) a conservator acting in accordance with the powers granted to the conservator under chapter 524; (3) a health care agent acting in accordance with the powers granted to the health care agent under chapter 145C; or (4) an attorney-in-fact acting in accordance with the powers granted to the attorney-in-fact by a written power of attorney under chapter 523. Subd. 29. Licensed health professional. "Licensed health professional" means a person licensed in Minnesota to practice a profession described in section 214.01, subdivision 2. Subd. 30. Licensed practical nurse. "Licensed practical nurse" has the meaning given in section 148.171, subdivision 8. Subd. 31. Licensed resident capacity. "Licensed resident capacity" means the resident occupancy level requested by a licensee and approved by the commissioner. Subd. 32. Licensee. "Licensee" means a person or legal entity to whom the commissioner issues a license for an assisted living facility and who is responsible for the management, control, and operation of a facility. Subd. 33. Maltreatment. "Maltreatment" means conduct described in section 626.5572, subdivision 15. Subd. 34. Management agreement. "Management agreement" means a written, executed agreement between a licensee and manager regarding the provision of certain services on behalf of the licensee. Subd. 35. Manager. "Manager" means an individual or legal entity designated by the licensee through a management agreement to act on behalf of the licensee in the on-site management of the assisted living facility. Subd. 36. Managerial official. "Managerial official" means an individual who has the decision-making authority related to the operation of the facility and the responsibility for the ongoing management or direction of the policies, services, or employees of the facility. Subd. 37. Medication. "Medication" means a prescription or over-the-counter drug. For purposes of this chapter only, medication includes dietary supplements. Subd. 38. Medication administration. "Medication administration" means performing a set of tasks that includes the following:
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(1) checking the resident's medication record; (2) preparing the medication as necessary; (3) administering the medication to the resident; (4) documenting the administration or reason for not administering the medication; and (5) reporting to a registered nurse or appropriate licensed health professional any concerns about the medication, the resident, or the resident's refusal to take the medication. Subd. 39. Medication management. "Medication management" means the provision of any of the following medication-related services to a resident: (1) performing medication setup; (2) administering medications; (3) storing and securing medications; (4) documenting medication activities; (5) verifying and monitoring the effectiveness of systems to ensure safe handling and administration; (6) coordinating refills; (7) handling and implementing changes to prescriptions; (8) communicating with the pharmacy about the resident's medications; and (9) coordinating and communicating with the prescriber. Subd. 40. Medication reconciliation. "Medication reconciliation" means the process of identifying the most accurate list of all medications the resident is taking, including the name, dosage, frequency, and route, by comparing the resident record to an external list of medications obtained from the resident, hospital, prescriber, or other provider. Subd. 41. Medication setup. "Medication setup" means arranging medications by a nurse, pharmacy, or authorized prescriber for later administration by the resident or by facility staff. Subd. 42. New construction. "New construction" means a new building, renovation, modification, reconstruction, physical changes altering the use of occupancy, or addition to a building. Subd. 43. Nurse. "Nurse" means a person who is licensed under sections 148.171 to 148.285. Subd. 44. Nutritionist. "Nutritionist" means a person licensed as a nutritionist under section 148.624. Subd. 45. Occupational therapist. "Occupational therapist" means a person who is licensed under sections 148.6401 to 148.6449. Subd. 46. Ombudsman. "Ombudsman" means the ombudsman for long-term care. Subd. 47. Over-the-counter drug. "Over-the-counter drug" means a drug that is not required by federal law to bear the symbol "Rx only."
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Subd. 48. Owner. "Owner" means an individual or legal entity that has a direct or indirect ownership interest of five percent or more in a licensee. For purposes of this chapter, "owner of a nonprofit corporation" means the president and treasurer of the board of directors or, for an entity owned by an employee stock ownership plan, means the president and treasurer of the entity. A government entity that is issued a license under this chapter shall be designated the owner. Subd. 49. Person-centered planning and service delivery. "Person-centered planning and service delivery" means services as defined in section 245D.07, subdivision 1a, paragraph (b). Subd. 50. Pharmacist. "Pharmacist" has the meaning given in section 151.01, subdivision 3. Subd. 51. Physical therapist. "Physical therapist" means a person who is licensed under sections 148.65 to 148.78. Subd. 52. Physician. "Physician" means a person who is licensed under chapter 147. Subd. 53. Prescriber. "Prescriber" means a person who is authorized by section 148.235; 151.01, subdivision 23; or 151.37 to prescribe prescription drugs. Subd. 54. Prescription. "Prescription" has the meaning given in section 151.01, subdivision 16a. Subd. 55. Provisional license. "Provisional license" means the initial license the commissioner issues after approval of a complete written application and before the commissioner completes the provisional license survey and determines that the provisional licensee is in substantial compliance. Subd. 56. Regularly scheduled. "Regularly scheduled" means ordered or planned to be completed at predetermined times or according to a predetermined routine. Subd. 57. Reminder. "Reminder" means providing a verbal or visual reminder to a resident. Subd. 58. Repeat violation. "Repeat violation" means the issuance of two or more correction orders within a 12-month period for a violation of the same provision of a statute or rule. Subd. 59. Resident. "Resident" means a person living in an assisted living facility who has executed an assisted living contract. Subd. 60. Resident record. "Resident record" means all records that document information about the services provided to the resident. Subd. 61. Respiratory therapist. "Respiratory therapist" means a person who is licensed under chapter 147C. Subd. 62. Secured dementia care unit. "Secured dementia care unit" means a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident's ability to exit, the secured area or setting. A secured dementia care unit is not solely an individual resident's living area. Subd. 63. Service plan. "Service plan" means the written plan between the resident and the provisional licensee or licensee about the services that will be provided to the resident. Subd. 64. Social worker. "Social worker" means a person who is licensed under chapter 148D or 148E. Subd. 65. Speech-language pathologist. "Speech-language pathologist" has the meaning given in section 148.512, subdivision 17.
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Subd. 66. Standby assistance. "Standby assistance" means the presence of another person within arm's reach to minimize the risk of injury while performing daily activities through physical intervention or cueing to assist a resident with an assistive task by providing cues, oversight, and minimal physical assistance. Subd. 67. Substantial compliance. "Substantial compliance" means complying with the requirements in this chapter sufficiently to prevent unacceptable health or safety risks to residents. Subd. 68. Supportive services. "Supportive services" means: (1) assistance with laundry, shopping, and household chores; (2) housekeeping services; (3) provision or assistance with meals or food preparation; (4) help with arranging for, or arranging transportation to, medical, social, recreational, personal, or social services appointments; (5) provision of social or recreational services; or (6) "I'm okay" check services. Arranging for services does not include making referrals, or contacting a service provider in an emergency. Subd. 69. Survey. "Survey" means an inspection of a licensee or applicant for licensure for compliance with this chapter and applicable rules. Subd. 70. Surveyor. "Surveyor" means a staff person of the department who is authorized to conduct surveys of assisted living facilities. Subd. 71. Treatment or therapy. "Treatment" or "therapy" means the provision of care, other than medications, ordered or prescribed by a licensed health professional and provided to a resident to cure, rehabilitate, or ease symptoms. Subd. 72. Unit of government. "Unit of government" means a city, county, town, school district, other political subdivision of the state, or agency of the state or federal government, that includes any instrumentality of a unit of government. Subd. 73. Unlicensed personnel. "Unlicensed personnel" means individuals not otherwise licensed or certified by a governmental health board or agency who provide services to a resident. Subd. 74. Verbal. "Verbal" means oral and not in writing. History: 2019 c 60 art 1 s 2,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 2, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 2, the effective date. 144G.09 COMMISSIONER OVERSIGHT AND AUTHORITY OVER ASSISTED LIVING FACILITIES. Subdivision 1. Regulations. The commissioner shall regulate assisted living facilities pursuant to this chapter. The regulations shall include the following:
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(1) provisions to assure, to the extent possible, the health, safety, well-being, and appropriate treatment of residents while respecting individual autonomy and choice; (2) requirements that facilities furnish the commissioner with specified information necessary to implement this chapter; (3) standards of training of facility personnel; (4) standards for the provision of assisted living services; (5) standards for medication management; (6) standards for supervision of assisted living services; (7) standards for resident evaluation or assessment; (8) standards for treatments and therapies; (9) requirements for the involvement of a resident's health care provider, the documentation of the health care provider's orders, if required, and the resident's service plan; (10) standards for the maintenance of accurate, current resident records; (11) the establishment of levels of licenses based on services provided; and (12) provisions to enforce these regulations and the assisted living bill of rights. [See Note.] Subd. 2. Regulatory functions. (a) The commissioner shall: (1) license, survey, and monitor without advance notice assisted living facilities in accordance with this chapter and rules; (2) survey every provisional licensee within one year of the provisional license issuance date subject to the provisional licensee providing assisted living services to residents; (3) survey assisted living facility licensees at least once every two years; (4) investigate complaints of assisted living facilities; (5) issue correction orders and assess civil penalties under sections 144G.30 and 144G.31; (6) take action as authorized in section 144G.20; and (7) take other action reasonably required to accomplish the purposes of this chapter. (b) The commissioner shall review blueprints for all new facility construction and must approve the plans before construction may be commenced. (c) The commissioner shall provide on-site review of the construction to ensure that all physical environment standards are met before the facility license is complete. [See Note.]
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Subd. 3. Rulemaking authorized. (a) The commissioner shall adopt rules for all assisted living facilities that promote person-centered planning and service delivery and optimal quality of life, and that ensure resident rights are protected, resident choice is allowed, and public health and safety is ensured. (b) On July 1, 2019, the commissioner shall begin rulemaking. (c) The commissioner shall adopt rules that include but are not limited to the following: (1) staffing appropriate for each licensure category to best protect the health and safety of residents no matter their vulnerability; (2) training prerequisites and ongoing training, including dementia care training and standards for demonstrating competency; (3) procedures for discharge planning and ensuring resident appeal rights; (4) initial assessments, continuing assessments, and a uniform assessment tool; (5) emergency disaster and preparedness plans; (6) uniform checklist disclosure of services; (7) a definition of serious injury that results from maltreatment; (8) conditions and fine amounts for planned closures; (9) procedures and timelines for the commissioner regarding termination appeals between facilities and the Office of Administrative Hearings; (10) establishing base fees and per-resident fees for each category of licensure; (11) considering the establishment of a maximum amount for any one fee; (12) procedures for relinquishing an assisted living facility with dementia care license and fine amounts for noncompliance; and (13) procedures to efficiently transfer existing housing with services registrants and home care licensees to the new assisted living facility licensure structure. (d) The commissioner shall publish the proposed rules by December 31, 2019, and shall publish final rules by December 31, 2020. History: 2019 c 60 art 1 s 34,41,47 NOTE: Subdivisions 1 and 2, as added by Laws 2019, chapter 60, article 1, section 34, are effective August 1, 2021. Laws 2019, chapter 60, article 1, section 34, the effective date. 144G.10 ASSISTED LIVING FACILITY LICENSE. Subdivision 1. License required. Beginning August 1, 2021, no assisted living facility may operate in Minnesota unless it is licensed under this chapter. The licensee is legally responsible for the management, control, and operation of the facility, regardless of the existence of a management agreement or subcontract. Nothing in this chapter shall in any way affect the rights and remedies available under other law. Subd. 2. Licensure categories. (a) The categories in this subdivision are established for assisted living facility licensure.
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(1) The assisted living facility category is for assisted living facilities that only provide assisted living services. (2) The assisted living facility with dementia care category is for assisted living facilities that provide assisted living services and dementia care services. An assisted living facility with dementia care may also provide dementia care services in a secured dementia care unit. (b) An assisted living facility that has a secured dementia care unit must be licensed as an assisted living facility with dementia care. Subd. 3. Licensure under other law. An assisted living facility licensed under this chapter is not required to also be licensed as a boarding establishment, food and beverage service establishment, hotel, motel, lodging establishment, resort, or restaurant under chapter 157. Subd. 4. Violations; penalty. (a) Operating an assisted living facility without a license is a misdemeanor, and the commissioner may also impose a fine. (b) A controlling individual of the facility in violation of this section is guilty of a misdemeanor. This paragraph shall not apply to any controlling individual who had no legal authority to affect or change decisions related to the operation of the facility. (c) The sanctions in this section do not restrict other available sanctions in law. History: 2019 c 60 art 1 s 3,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 3, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 3, the effective date. 144G.11 APPLICABILITY OF OTHER LAWS. Assisted living facilities: (1) are subject to and must comply with chapter 504B; (2) must comply with section 325F.72; and (3) are not required to obtain a lodging license under chapter 157 and related rules. History: 2019 c 60 art 1 s 44,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 44, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 44, the effective date. 144G.12 APPLICATION FOR LICENSURE. Subdivision 1. License applications. Each application for an assisted living facility license, including provisional and renewal applications, must include information sufficient to show that the applicant meets the requirements of licensure, including: (1) the business name and legal entity name of the licensee, and the street address and mailing address of the facility; (2) the names, e-mail addresses, telephone numbers, and mailing addresses of all owners, controlling individuals, managerial officials, and the assisted living director;
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(3) the name and e-mail address of the managing agent and manager, if applicable; (4) the licensed resident capacity and the license category; (5) the license fee in the amount specified in section 144.122; (6) documentation of compliance with the background study requirements in section 144G.13 for the owner, controlling individuals, and managerial officials. Each application for a new license must include documentation for the applicant and for each individual with five percent or more direct or indirect ownership in the applicant; (7) evidence of workers' compensation coverage as required by sections 176.181 and 176.182; (8) documentation that the facility has liability coverage; (9) a copy of the executed lease agreement between the landlord and the licensee, if applicable; (10) a copy of the management agreement, if applicable; (11) a copy of the operations transfer agreement or similar agreement, if applicable; (12) an organizational chart that identifies all organizations and individuals with an ownership interest in the licensee of five percent or greater and that specifies their relationship with the licensee and with each other; (13) whether the applicant, owner, controlling individual, managerial official, or assisted living director of the facility has ever been convicted of: (i) a crime or found civilly liable for a federal or state felony level offense that was detrimental to the best interests of the facility and its resident within the last ten years preceding submission of the license application. Offenses include: felony crimes against persons and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions; financial crimes such as extortion, embezzlement, income tax evasion, insurance fraud, and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions; any felonies involving malpractice that resulted in a conviction of criminal neglect or misconduct; and any felonies that would result in a mandatory exclusion under section 1128(a) of the Social Security Act; (ii) any misdemeanor conviction, under federal or state law, related to: the delivery of an item or service under Medicaid or a state health care program, or the abuse or neglect of a patient in connection with the delivery of a health care item or service; (iii) any misdemeanor conviction, under federal or state law, related to theft, fraud, embezzlement, breach of fiduciary duty, or other financial misconduct in connection with the delivery of a health care item or service; (iv) any felony or misdemeanor conviction, under federal or state law, relating to the interference with or obstruction of any investigation into any criminal offense described in Code of Federal Regulations, title 42, section 1001.101 or 1001.201; (v) any felony or misdemeanor conviction, under federal or state law, relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance; (vi) any felony or gross misdemeanor that relates to the operation of a nursing home or assisted living facility or directly affects resident safety or care during that period;
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(vii) any revocation or suspension of a license to provide health care by any state licensing authority. This includes the surrender of such a license while a formal disciplinary proceeding was pending before a state licensing authority; (viii) any revocation or suspension of accreditation; or (ix) any suspension or exclusion from participation in, or any sanction imposed by, a federal or state health care program, or any debarment from participation in any federal executive branch procurement or nonprocurement program; (14) whether, in the preceding three years, the applicant or any owner, controlling individual, managerial official, or assisted living director of the facility has a record of defaulting in the payment of money collected for others, including the discharge of debts through bankruptcy proceedings; (15) the signature of the owner of the licensee, or an authorized agent of the licensee; (16) identification of all states where the applicant or individual having a five percent or more ownership, currently or previously has been licensed as an owner or operator of a long-term care, community-based, or health care facility or agency where its license or federal certification has been denied, suspended, restricted, conditioned, refused, not renewed, or revoked under a private or state-controlled receivership, or where these same actions are pending under the laws of any state or federal authority; (17) statistical information required by the commissioner; and (18) any other information required by the commissioner. Subd. 2. Authorized agents. (a) An application for an assisted living facility license or for renewal of a facility license must specify one or more owners, controlling individuals, or employees as authorized agents who can accept service on behalf of the licensee in proceedings under this chapter. (b) Notwithstanding any law to the contrary, personal service on the authorized agent named in the application is deemed to be service on all of the controlling individuals or managerial officials of the facility, and it is not a defense to any action arising under this chapter that personal service was not made on each controlling individual or managerial official of the facility. The designation of one or more controlling individuals or managerial officials under this subdivision shall not affect the legal responsibility of any other controlling individual or managerial official under this chapter. Subd. 3. Fees. (a) An initial applicant, renewal applicant, or applicant filing a change of ownership for assisted living facility licensure must submit the application fee required in section 144.122 to the commissioner along with a completed application. (b) Fees collected under this section shall be deposited in the state treasury and credited to the state government special revenue fund. All fees are nonrefundable. Subd. 4. Fines and penalties. (a) The penalty for late submission of the renewal application less than 30 days before the expiration date of the license or after expiration of the license is $200. The penalty for operating a facility after expiration of the license and before a renewal license is issued is $250 each day after expiration of the license until the renewal license issuance date. The facility is still subject to the misdemeanor penalties for operating after license expiration.
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(b) Fines and penalties collected under this subdivision shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner to implement the recommendations of the advisory council established in section 144A.4799. History: 2019 c 60 art 1 s 5,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 5, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 5, the effective date. 144G.13 BACKGROUND STUDIES OF LICENSE APPLICANTS. Subdivision 1. Background studies required. (a) Before the commissioner issues a provisional license, issues a license as a result of an approved change of ownership, or renews a license, a managerial official or a natural person who is an owner with direct ownership interest is required to undergo a background study under section 144.057. No person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C. For the purposes of this section, managerial officials subject to the background study requirement are individuals who provide direct contact. Nothing in this section shall be construed to prohibit the facility from requiring self-disclosure of criminal conviction information. (b) The commissioner shall not issue a license if any controlling individual, including a managerial official, has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C. (c) Termination of an employee in good faith reliance on information or records obtained under this section regarding a confirmed conviction does not subject the assisted living facility to civil liability or liability for unemployment benefits. Subd. 2. Reconsideration. (a) If the individual requests reconsideration of a disqualification under section 144.057 or chapter 245C and the commissioner sets aside or rescinds the disqualification, the individual is eligible to be involved in the management, operation, or control of the facility. (b) If an individual has a disqualification under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's disqualification is barred from a set aside, and the individual must not be involved in the management, operation, or control of the facility. Subd. 3. Data classification. Data collected under this section shall be classified as private data on individuals under section 13.02, subdivision 12. History: 2019 c 60 art 1 s 7,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 7, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 7, the effective date. 144G.15 CONSIDERATION OF APPLICATIONS. (a) Before issuing a provisional license or license or renewing a license, the commissioner shall consider an applicant's compliance history in providing care in a facility that provides care to children, the elderly, ill individuals, or individuals with disabilities. (b) The applicant's compliance history shall include repeat violation, rule violations, and any license or certification involuntarily suspended or terminated during an enforcement process.
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(c) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license or impose conditions if: (1) the applicant fails to provide complete and accurate information on the application and the commissioner concludes that the missing or corrected information is needed to determine if a license shall be granted; (2) the applicant, knowingly or with reason to know, made a false statement of a material fact in an application for the license or any data attached to the application or in any matter under investigation by the department; (3) the applicant refused to allow agents of the commissioner to inspect its books, records, and files related to the license application, or any portion of the premises; (4) the applicant willfully prevented, interfered with, or attempted to impede in any way: (i) the work of any authorized representative of the commissioner, the ombudsman for long-term care, or the ombudsman for mental health and developmental disabilities; or (ii) the duties of the commissioner, local law enforcement, city or county attorneys, adult protection, county case managers, or other local government personnel; (5) the applicant has a history of noncompliance with federal or state regulations that were detrimental to the health, welfare, or safety of a resident or a client; or (6) the applicant violates any requirement in this chapter. (d) If a license is denied, the applicant has the reconsideration rights available under section 144G.16, subdivision 4. History: 2019 c 60 art 1 s 10,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 10, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 10, the effective date. 144G.16 PROVISIONAL LICENSE. Subdivision 1. Provisional license. Beginning August 1, 2021, for new assisted living facility license applicants, the commissioner shall issue a provisional license from one of the licensure categories specified in section 144G.10, subdivision 2. A provisional license is effective for up to one year from the initial effective date of the license, except that a provisional license may be extended according to subdivisions 2, paragraph (d), and 3. Subd. 2. Initial survey. (a) During the provisional license period, the commissioner shall survey the provisional licensee after the commissioner is notified or has evidence that the provisional licensee is providing assisted living services to at least one resident. (b) Within two days of beginning to provide assisted living services, the provisional licensee must provide notice to the commissioner that it is providing assisted living services by sending an e-mail to the e-mail address provided by the commissioner. (c) If the provisional licensee does not provide services during the provisional license period, the provisional license shall expire at the end of the period and the applicant must reapply. (d) If the provisional licensee notifies the commissioner that the licensee is providing assisted living services within 45 calendar days prior to expiration of the provisional license, the commissioner may extend
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the provisional license for up to 60 calendar days in order to allow the commissioner to complete the on-site survey required under this section and follow-up survey visits. Subd. 3. Licensure; termination or extension of provisional licenses. (a) If the provisional licensee is in substantial compliance with the survey, the commissioner shall issue a facility license. (b) If the provisional licensee is not in substantial compliance with the initial survey, the commissioner shall either: (1) not issue the facility license and terminate the provisional license; or (2) extend the provisional license for a period not to exceed 90 calendar days and apply conditions necessary to bring the facility into substantial compliance. If the provisional licensee is not in substantial compliance with the survey within the time period of the extension or if the provisional licensee does not satisfy the license conditions, the commissioner may deny the license. Subd. 4. Reconsideration. (a) If a provisional licensee whose assisted living facility license has been denied or extended with conditions disagrees with the conclusions of the commissioner, then the provisional licensee may request a reconsideration by the commissioner. The reconsideration request process must be conducted internally by the commissioner and chapter 14 does not apply. (b) The provisional licensee requesting the reconsideration must make the request in writing and must list and describe the reasons why the provisional licensee disagrees with the decision to deny the facility license or the decision to extend the provisional license with conditions. (c) The reconsideration request and supporting documentation must be received by the commissioner within 15 calendar days after the date the provisional licensee receives the denial or provisional license with conditions. Subd. 5. Continued operation. A provisional licensee whose license is denied is permitted to continue operating during the period of time when: (1) a reconsideration is in process; (2) an extension of the provisional license and terms associated with it is in active negotiation between the commissioner and the licensee, and the commissioner confirms the negotiation is active; or (3) a transfer of residents to a new facility is underway and not all of the residents have relocated. Subd. 6. Requirements for notice and transfer. A provisional licensee whose license is denied must comply with the requirements for notification and the coordinated move of residents in sections 144G.52 and 144G.55. Subd. 7. Fines. The fee for failure to comply with the notification requirements in section 144G.52, subdivision 7, is $1,000. History: 2019 c 60 art 1 s 4,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 4, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 4, the effective date. 144G.17 LICENSE RENEWAL. A license that is not a provisional license may be renewed for a period of up to one year if the licensee: (1) submits an application for renewal in the format provided by the commissioner at least 60 calendar days before expiration of the license;
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(2) submits the renewal fee under section 144G.12, subdivision 3; (3) submits the late fee under section 144G.12, subdivision 4, if the renewal application is received less than 30 days before the expiration date of the license or after the expiration of the license; (4) provides information sufficient to show that the applicant meets the requirements of licensure, including items required under section 144G.12, subdivision 1; and (5) provides any other information deemed necessary by the commissioner. History: 2019 c 60 art 1 s 8,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 8, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 8, the effective date. 144G.18 NOTIFICATION OF CHANGES IN INFORMATION. A provisional licensee or licensee shall notify the commissioner in writing prior to a change in the manager or authorized agent and within 60 calendar days after any change in the information required in section 144G.12, subdivision 1, paragraph (a), clause (1), (3), (4), (17), or (18). History: 2019 c 60 art 1 s 9,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 9, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 9, the effective date. 144G.19 TRANSFER OF LICENSE PROHIBITED. Subdivision 1. Transfers prohibited. An assisted living facility license may not be transferred to another party. Subd. 2. New license required. (a) A prospective licensee must apply for a license prior to operating a currently licensed assisted living facility. The new license, if issued, shall not be a provisional license. The licensee must change whenever one of the following events occur: (1) the form of the licensee's legal entity structure is converted or changed to a different type of legal entity structure; (2) the licensee dissolves, consolidates, or merges with another legal organization and the licensee's legal organization does not survive; (3) within the previous 24 months, 50 percent or more of the licensee is transferred, whether by a single transaction or multiple transactions, to: (i) a different person; or (ii) a person who had less than a five percent ownership interest in the facility at the time of the first transaction; or (4) any other event or combination of events that results in a substitution, elimination, or withdrawal of the licensee's responsibility for the facility. (b) The prospective licensee must provide written notice to the department at least 60 calendar days prior to the anticipated date of the change of licensee.
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Subd. 3. Survey required. For all new licensees after a change of ownership, the commissioner shall complete a survey within six months after the new license is issued. History: 2019 c 60 art 1 s 6,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 6, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 6, the effective date. ENFORCEMENT 144G.20 ENFORCEMENT. Subdivision 1. Conditions. (a) The commissioner may refuse to grant a provisional license, refuse to grant a license as a result of a change in ownership, refuse to renew a license, suspend or revoke a license, or impose a conditional license if the owner, controlling individual, or employee of an assisted living facility: (1) is in violation of, or during the term of the license has violated, any of the requirements in this chapter or adopted rules; (2) permits, aids, or abets the commission of any illegal act in the provision of assisted living services; (3) performs any act detrimental to the health, safety, and welfare of a resident; (4) obtains the license by fraud or misrepresentation; (5) knowingly makes a false statement of a material fact in the application for a license or in any other record or report required by this chapter; (6) denies representatives of the department access to any part of the facility's books, records, files, or employees; (7) interferes with or impedes a representative of the department in contacting the facility's residents; (8) interferes with or impedes ombudsman access according to section 256.9742, subdivision 4; (9) interferes with or impedes a representative of the department in the enforcement of this chapter or fails to fully cooperate with an inspection, survey, or investigation by the department; (10) destroys or makes unavailable any records or other evidence relating to the assisted living facility's compliance with this chapter; (11) refuses to initiate a background study under section 144.057 or 245A.04; (12) fails to timely pay any fines assessed by the commissioner; (13) violates any local, city, or township ordinance relating to housing or assisted living services; (14) has repeated incidents of personnel performing services beyond their competency level; or (15) has operated beyond the scope of the assisted living facility's license category. (b) A violation by a contractor providing the assisted living services of the facility is a violation by the facility.
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Subd. 2. Terms to suspension or conditional license. (a) A suspension or conditional license designation may include terms that must be completed or met before a suspension or conditional license designation is lifted. A conditional license designation may include restrictions or conditions that are imposed on the assisted living facility. Terms for a suspension or conditional license may include one or more of the following and the scope of each will be determined by the commissioner: (1) requiring a consultant to review, evaluate, and make recommended changes to the facility's practices and submit reports to the commissioner at the cost of the facility; (2) requiring supervision of the facility or staff practices at the cost of the facility by an unrelated person who has sufficient knowledge and qualifications to oversee the practices and who will submit reports to the commissioner; (3) requiring the facility or employees to obtain training at the cost of the facility; (4) requiring the facility to submit reports to the commissioner; (5) prohibiting the facility from admitting any new residents for a specified period of time; or (6) any other action reasonably required to accomplish the purpose of this subdivision and subdivision 1. (b) A facility subject to this subdivision may continue operating during the period of time residents are being transferred to another service provider. Subd. 3. Immediate temporary suspension. (a) In addition to any other remedies provided by law, the commissioner may, without a prior contested case hearing, immediately temporarily suspend a license or prohibit delivery of housing or services by a facility for not more than 90 calendar days or issue a conditional license, if the commissioner determines that there are: (1) Level 4 violations; or (2) violations that pose an imminent risk of harm to the health or safety of residents. (b) For purposes of this subdivision, "Level 4" has the meaning given in section 144G.31. (c) A notice stating the reasons for the immediate temporary suspension or conditional license and informing the licensee of the right to an expedited hearing under subdivision 17 must be delivered by personal service to the address shown on the application or the last known address of the licensee. The licensee may appeal an order immediately temporarily suspending a license or issuing a conditional license. The appeal must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the commissioner within five calendar days after the licensee receives notice. If an appeal is made by personal service, it must be received by the commissioner within five calendar days after the licensee received the order. (d) A licensee whose license is immediately temporarily suspended must comply with the requirements for notification and transfer of residents in subdivision 15. The requirements in subdivision 9 remain if an appeal is requested. Subd. 4. Mandatory revocation. Notwithstanding the provisions of subdivision 13, paragraph (a), the commissioner must revoke a license if a controlling individual of the facility is convicted of a felony or gross misdemeanor that relates to operation of the facility or directly affects resident safety or care. The
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commissioner shall notify the facility and the Office of Ombudsman for Long-Term Care 30 calendar days in advance of the date of revocation. Subd. 5. Owners and managerial officials; refusal to grant license. (a) The owners and managerial officials of a facility whose Minnesota license has not been renewed or whose Minnesota license has been revoked because of noncompliance with applicable laws or rules shall not be eligible to apply for nor will be granted an assisted living facility license under this chapter or a home care provider license under chapter 144A, or be given status as an enrolled personal care assistance provider agency or personal care assistant by the Department of Human Services under section 256B.0659, for five years following the effective date of the nonrenewal or revocation. If the owners or managerial officials already have enrollment status, the Department of Human Services shall terminate that enrollment. (b) The commissioner shall not issue a license to a facility for five years following the effective date of license nonrenewal or revocation if the owners or managerial officials, including any individual who was an owner or managerial official of another licensed provider, had a Minnesota license that was not renewed or was revoked as described in paragraph (a). (c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall suspend or revoke, the license of a facility that includes any individual as an owner or managerial official who was an owner or managerial official of a facility whose Minnesota license was not renewed or was revoked as described in paragraph (a) for five years following the effective date of the nonrenewal or revocation. (d) The commissioner shall notify the facility 30 calendar days in advance of the date of nonrenewal, suspension, or revocation of the license. Subd. 6. Requesting a stay of adverse actions required by owners and managerial officials restrictions. Within ten business days after the receipt of the notification, the facility may request, in writing, that the commissioner stay the nonrenewal, revocation, or suspension of the license. The facility shall specify the reasons for requesting the stay; the steps that will be taken to attain or maintain compliance with the licensure laws and regulations; any limits on the authority or responsibility of the owners or managerial officials whose actions resulted in the notice of nonrenewal, revocation, or suspension; and any other information to establish that the continuing affiliation with these individuals will not jeopardize resident health, safety, or well-being. Subd. 7. Granting a stay of adverse actions required by owners and managerial officials restrictions. The commissioner shall determine whether the stay will be granted within 30 calendar days of receiving the facility's request. The commissioner may propose additional restrictions or limitations on the facility's license and require that granting the stay be contingent upon compliance with those provisions. The commissioner shall take into consideration the following factors when determining whether the stay should be granted: (1) the threat that continued involvement of the owners and managerial officials with the facility poses to resident health, safety, and well-being; (2) the compliance history of the facility; and (3) the appropriateness of any limits suggested by the facility. If the commissioner grants the stay, the order shall include any restrictions or limitation on the provider's license. The failure of the facility to comply with any restrictions or limitations shall result in the immediate removal of the stay and the commissioner shall take immediate action to suspend, revoke, or not renew the license.
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Subd. 8. Controlling individual restrictions. (a) The commissioner has discretion to bar any controlling individual of a facility if the person was a controlling individual of any other nursing home or assisted living facility in the previous two-year period and: (1) during that period of time the nursing home or assisted living facility incurred the following number of uncorrected or repeated violations: (i) two or more repeated violations that created an imminent risk to direct resident care or safety; or (ii) four or more uncorrected violations that created an imminent risk to direct resident care or safety; or (2) during that period of time, was convicted of a felony or gross misdemeanor that related to the operation of the nursing home or assisted living facility, or directly affected resident safety or care. (b) When the commissioner bars a controlling individual under this subdivision, the controlling individual may appeal the commissioner's decision under chapter 14. Subd. 9. Exception to controlling individual restrictions. Subdivision 8 does not apply to any controlling individual of the facility who had no legal authority to affect or change decisions related to the operation of the nursing home or assisted living facility that incurred the uncorrected violations. Subd. 10. Stay of adverse action required by controlling individual restrictions. (a) In lieu of revoking, suspending, or refusing to renew the license of a facility where a controlling individual was disqualified by subdivision 8, paragraph (a), clause (1), the commissioner may issue an order staying the revocation, suspension, or nonrenewal of the facility's license. The order may but need not be contingent upon the facility's compliance with restrictions and conditions imposed on the license to ensure the proper operation of the facility and to protect the health, safety, comfort, treatment, and well-being of the residents in the facility. The decision to issue an order for a stay must be made within 90 calendar days of the commissioner's determination that a controlling individual of the facility is disqualified by subdivision 8, paragraph (a), clause (1), from operating a facility. (b) In determining whether to issue a stay and to impose conditions and restrictions, the commissioner must consider the following factors: (1) the ability of the controlling individual to operate other facilities in accordance with the licensure rules and laws; (2) the conditions in the nursing home or assisted living facility that received the number and type of uncorrected or repeated violations described in subdivision 8, paragraph (a), clause (1); and (3) the conditions and compliance history of each of the nursing homes and assisted living facilities owned or operated by the controlling individual. (c) The commissioner's decision to exercise the authority under this subdivision in lieu of revoking, suspending, or refusing to renew the license of the facility is not subject to administrative or judicial review. (d) The order for the stay of revocation, suspension, or nonrenewal of the facility license must include any conditions and restrictions on the license that the commissioner deems necessary based on the factors listed in paragraph (b). (e) Prior to issuing an order for stay of revocation, suspension, or nonrenewal, the commissioner shall inform the licensee and the controlling individual in writing of any conditions and restrictions that will be
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imposed. The controlling individual shall, within ten working days, notify the commissioner in writing of a decision to accept or reject the conditions and restrictions. If any of the conditions or restrictions are rejected, the commissioner must either modify the conditions and restrictions or take action to suspend, revoke, or not renew the facility's license. (f) Upon issuance of the order for a stay of revocation, suspension, or nonrenewal, the controlling individual shall be responsible for compliance with the conditions and restrictions. Any time after the conditions and restrictions have been in place for 180 days, the controlling individual may petition the commissioner for removal or modification of the conditions and restrictions. The commissioner must respond to the petition within 30 days of receipt of the written petition. If the commissioner denies the petition, the controlling individual may request a hearing under chapter 14. Any hearing shall be limited to a determination of whether the conditions and restrictions shall be modified or removed. At the hearing, the controlling individual bears the burden of proof. (g) The failure of the controlling individual to comply with the conditions and restrictions contained in the order for stay shall result in the immediate removal of the stay and the commissioner shall take action to suspend, revoke, or not renew the license. (h) The conditions and restrictions are effective for two years after the date they are imposed. (i) Nothing in this subdivision shall be construed to limit in any way the commissioner's ability to impose other sanctions against a licensee under the standards in state or federal law whether or not a stay of revocation, suspension, or nonrenewal is issued. Subd. 11. Mandatory proceedings. (a) The commissioner must initiate proceedings within 60 calendar days of notification to suspend or revoke a facility's license or must refuse to renew a facility's license if within the preceding two years the facility has incurred the following number of uncorrected or repeated violations: (1) two or more uncorrected violations or one or more repeated violations that created an imminent risk to direct resident care or safety; or (2) four or more uncorrected violations or two or more repeated violations of any nature for which the fines are in the four highest daily fine categories prescribed in rule. (b) Notwithstanding paragraph (a), the commissioner is not required to revoke, suspend, or refuse to renew a facility's license if the facility corrects the violation. Subd. 12. Notice to residents. (a) Within five business days after proceedings are initiated by the commissioner to revoke or suspend a facility's license, or a decision by the commissioner not to renew a living facility's license, the controlling individual of the facility or a designee must provide to the commissioner and the ombudsman for long-term care the names of residents and the names and addresses of the residents' designated representatives and legal representatives, and family or other contacts listed in the assisted living contract. (b) The controlling individual or designees of the facility must provide updated information each month until the proceeding is concluded. If the controlling individual or designee of the facility fails to provide the information within this time, the facility is subject to the issuance of: (1) a correction order; and (2) a penalty assessment by the commissioner in rule.
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(c) Notwithstanding subdivisions 21 and 22, any correction order issued under this subdivision must require that the facility immediately comply with the request for information and that, as of the date of the issuance of the correction order, the facility shall forfeit to the state a $500 fine the first day of noncompliance and an increase in the $500 fine by $100 increments for each day the noncompliance continues. (d) Information provided under this subdivision may be used by the commissioner or the ombudsman for long-term care only for the purpose of providing affected consumers information about the status of the proceedings. (e) Within ten business days after the commissioner initiates proceedings to revoke, suspend, or not renew a facility license, the commissioner must send a written notice of the action and the process involved to each resident of the facility, legal representatives and designated representatives, and at the commissioner's discretion, additional resident contacts. (f) The commissioner shall provide the ombudsman for long-term care with monthly information on the department's actions and the status of the proceedings. Subd. 13. Notice to facility. (a) Prior to any suspension, revocation, or refusal to renew a license, the facility shall be entitled to notice and a hearing as provided by sections 14.57 to 14.69. The hearing must commence within 60 calendar days after the proceedings are initiated. In addition to any other remedy provided by law, the commissioner may, without a prior contested case hearing, temporarily suspend a license or prohibit delivery of services by a provider for not more than 90 calendar days, or issue a conditional license if the commissioner determines that there are Level 3 violations that do not pose an imminent risk of harm to the health or safety of the facility residents, provided: (1) advance notice is given to the facility; (2) after notice, the facility fails to correct the problem; (3) the commissioner has reason to believe that other administrative remedies are not likely to be effective; and (4) there is an opportunity for a contested case hearing within 30 calendar days unless there is an extension granted by an administrative law judge. (b) If the commissioner determines there are Level 4 violations or violations that pose an imminent risk of harm to the health or safety of the facility residents, the commissioner may immediately temporarily suspend a license, prohibit delivery of services by a facility, or issue a conditional license without meeting the requirements of paragraph (a), clauses (1) to (4). For the purposes of this subdivision, "Level 3" and "Level 4" have the meanings given in section 144G.31. Subd. 14. Request for hearing. A request for hearing must be in writing and must: (1) be mailed or delivered to the commissioner; (2) contain a brief and plain statement describing every matter or issue contested; and (3) contain a brief and plain statement of any new matter that the applicant or assisted living facility believes constitutes a defense or mitigating factor. Subd. 15. Plan required. (a) The process of suspending, revoking, or refusing to renew a license must include a plan for transferring affected residents' cares to other providers by the facility. The commissioner
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shall monitor the transfer plan. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension, the licensee shall provide the commissioner, the lead agencies as defined in section 256B.0911, county adult protection and case managers, and the ombudsman for long-term care with the following information: (1) a list of all residents, including full names and all contact information on file; (2) a list of the resident's legal representatives and designated representatives and family or other contacts listed in the assisted living contract, including full names and all contact information on file; (3) the location or current residence of each resident; (4) the payor sources for each resident, including payor source identification numbers; and (5) for each resident, a copy of the resident's service plan and a list of the types of services being provided. (b) The revocation, refusal to renew, or suspension notification requirement is satisfied by mailing the notice to the address in the license record. The licensee shall cooperate with the commissioner and the lead agencies, county adult protection and case managers, and the ombudsman for long-term care during the process of transferring care of residents to qualified providers. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension action, the facility must notify and disclose to each of the residents, or the resident's legal and designated representatives or emergency contact persons, that the commissioner is taking action against the facility's license by providing a copy of the revocation, refusal to renew, or suspension notice issued by the commissioner. If the facility does not comply with the disclosure requirements in this section, the commissioner shall notify the residents, legal and designated representatives, or emergency contact persons about the actions being taken. Lead agencies, county adult protection and case managers, and the Office of Ombudsman for Long-Term Care may also provide this information. The revocation, refusal to renew, or suspension notice is public data except for any private data contained therein. (c) A facility subject to this subdivision may continue operating while residents are being transferred to other service providers. Subd. 16. Hearing. Within 15 business days of receipt of the licensee's timely appeal of a sanction under this section, other than for a temporary suspension, the commissioner shall request assignment of an administrative law judge. The commissioner's request must include a proposed date, time, and place of hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 90 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause or for purposes of discussing settlement. In no case shall one or more extensions be granted for a total of more than 90 calendar days unless there is a criminal action pending against the licensee. If, while a licensee continues to operate pending an appeal of an order for revocation, suspension, or refusal to renew a license, the commissioner identifies one or more new violations of law that meet the requirements of Level 3 or Level 4 violations as defined in section 144G.31, the commissioner shall act immediately to temporarily suspend the license. Subd. 17. Expedited hearing. (a) Within five business days of receipt of the licensee's timely appeal of a temporary suspension or issuance of a conditional license, the commissioner shall request assignment of an administrative law judge. The request must include a proposed date, time, and place of a hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 30 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause. The commissioner shall issue a notice of hearing by certified mail or personal service at least ten business days before the hearing. Certified
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mail to the last known address is sufficient. The scope of the hearing shall be limited solely to the issue of whether the temporary suspension or issuance of a conditional license should remain in effect and whether there is sufficient evidence to conclude that the licensee's actions or failure to comply with applicable laws are Level 3 or Level 4 violations as defined in section 144G.31, or that there were violations that posed an imminent risk of harm to the resident's health and safety. (b) The administrative law judge shall issue findings of fact, conclusions, and a recommendation within ten business days from the date of hearing. The parties shall have ten calendar days to submit exceptions to the administrative law judge's report. The record shall close at the end of the ten-day period for submission of exceptions. The commissioner's final order shall be issued within ten business days from the close of the record. When an appeal of a temporary immediate suspension or conditional license is withdrawn or dismissed, the commissioner shall issue a final order affirming the temporary immediate suspension or conditional license within ten calendar days of the commissioner's receipt of the withdrawal or dismissal. The licensee is prohibited from operation during the temporary suspension period. (c) When the final order under paragraph (b) affirms an immediate suspension, and a final licensing sanction is issued under subdivisions 1 and 2 and the licensee appeals that sanction, the licensee is prohibited from operation pending a final commissioner's order after the contested case hearing conducted under chapter 14. (d) A licensee whose license is temporarily suspended must comply with the requirements for notification and transfer of residents under subdivision 15. These requirements remain if an appeal is requested. Subd. 18. Time limits for appeals. To appeal the assessment of civil penalties under section 144G.31, and an action against a license under this section, a licensee must request a hearing no later than 15 business days after the licensee receives notice of the action. Subd. 19. Relicensing. If a facility license is revoked, a new application for license may be considered by the commissioner when the conditions upon which the revocation was based have been corrected and satisfactory evidence of this fact has been furnished to the commissioner. A new license may be granted after an inspection has been made and the facility has complied with all provisions of this chapter and adopted rules. Subd. 20. Informal conference. At any time, the commissioner and the applicant, licensee, manager if applicable, or facility may hold an informal conference to exchange information, clarify issues, or resolve issues. Subd. 21. Injunctive relief. In addition to any other remedy provided by law, the commissioner may bring an action in district court to enjoin a person who is involved in the management, operation, or control of a facility or an employee of the facility from illegally engaging in activities regulated by this chapter. The commissioner may bring an action under this subdivision in the district court in Ramsey County or in the district in which the facility is located. The court may grant a temporary restraining order in the proceeding if continued activity by the person who is involved in the management, operation, or control of a facility, or by an employee of the facility, would create an imminent risk of harm to a resident. Subd. 22. Subpoena. In matters pending before the commissioner under this chapter, the commissioner may issue subpoenas and compel the attendance of witnesses and the production of all necessary papers, books, records, documents, and other evidentiary material. If a person fails or refuses to comply with a subpoena or order of the commissioner to appear or testify regarding any matter about which the person may be lawfully questioned or to produce any papers, books, records, documents, or evidentiary materials in the matter to be heard, the commissioner may apply to the district court in any district, and the court shall
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order the person to comply with the commissioner's order or subpoena. The commissioner may administer oaths to witnesses or take their affirmation. Depositions may be taken in or outside the state in the manner provided by law for taking depositions in civil actions. A subpoena or other process or paper may be served on a named person anywhere in the state by an officer authorized to serve subpoenas in civil actions, with the same fees and mileage and in the same manner as prescribed by law for a process issued out of a district court. A person subpoenaed under this subdivision shall receive the same fees, mileage, and other costs that are paid in proceedings in district court. History: 2019 c 60 art 1 s 24,38,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 24 and 38, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 24 and 38, the effective dates. SURVEYS, CORRECTION ORDERS, AND FINES 144G.30 SURVEYS AND INVESTIGATIONS. Subdivision 1. Regulatory powers. (a) The Department of Health is the exclusive state agency charged with the responsibility and duty of surveying and investigating all assisted living facilities required to be licensed under this chapter. The commissioner of health shall enforce all sections of this chapter and the rules adopted under this chapter. (b) The commissioner, upon request to the facility, must be given access to relevant information, records, incident reports, and other documents in the possession of the facility if the commissioner considers them necessary for the discharge of responsibilities. For purposes of surveys and investigations and securing information to determine compliance with licensure laws and rules, the commissioner need not present a release, waiver, or consent to the individual. The identities of residents must be kept private as defined in section 13.02, subdivision 12. Subd. 2. Surveys. The commissioner shall conduct a survey of each assisted living facility on a frequency of at least once every two years. The commissioner may conduct surveys more frequently than every two years based on the license category, the facility's compliance history, the number of residents served, or other factors as determined by the commissioner deemed necessary to ensure the health, safety, and welfare of residents and compliance with the law. Subd. 3. Scheduling surveys. Surveys and investigations shall be conducted without advance notice to the facilities. Surveyors may contact the facility on the day of a survey to arrange for someone to be available at the survey site. The contact does not constitute advance notice. The surveyor must provide presurvey notification to the Office of Ombudsman for Long-Term Care. Subd. 4. Information provided by facility. (a) The assisted living facility shall provide accurate and truthful information to the department during a survey, investigation, or other licensing activities. (b) Upon request of a surveyor, assisted living facilities shall within a reasonable period of time provide a list of current and past residents and their legal representatives and designated representatives that includes addresses and telephone numbers and any other information requested about the services to residents. Subd. 5. Correction orders. (a) A correction order may be issued whenever the commissioner finds upon survey or during a complaint investigation that a facility, a managerial official, or an employee of the facility is not in compliance with this chapter. The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction.
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(b) The commissioner shall mail or e-mail copies of any correction order to the facility within 30 calendar days after the survey exit date. A copy of each correction order and copies of any documentation supplied to the commissioner shall be kept on file by the facility and public documents shall be made available for viewing by any person upon request. Copies may be kept electronically. (c) By the correction order date, the facility must document in the facility's records any action taken to comply with the correction order. The commissioner may request a copy of this documentation and the facility's action to respond to the correction order in future surveys, upon a complaint investigation, and as otherwise needed. Subd. 6. Follow-up surveys. The commissioner may conduct follow-up surveys to determine if the facility has corrected deficient issues and systems identified during a survey or complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint investigations, shall be concluded with an exit conference and written information provided on the process for requesting a reconsideration of the survey results. Subd. 7. Required follow-up surveys. For assisted living facilities that have Level 3 or Level 4 violations under section 144G.31, the commissioner shall conduct a follow-up survey within 90 calendar days of the survey. When conducting a follow-up survey, the surveyor shall focus on whether the previous violations have been corrected and may also address any new violations that are observed while evaluating the corrections that have been made. Subd. 8. Notice of noncompliance. If the commissioner finds that the applicant or a facility has not corrected violations by the date specified in the correction order or conditional license resulting from a survey or complaint investigation, the commissioner shall provide a notice of noncompliance with a correction order by e-mailing the notice of noncompliance to the facility. The noncompliance notice must list the violations not corrected. History: 2019 c 60 art 1 s 35,36,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 35 and 36, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 35 and 36, the effective dates. 144G.31 VIOLATIONS AND FINES. Subdivision 1. Categories of violations. Correction orders for violations are categorized by both level and scope. Subd. 2. Levels of violations. Correction orders for violations are categorized by level as follows: (1) Level 1 is a violation that has no potential to cause more than a minimal impact on the resident and does not affect health or safety; (2) Level 2 is a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety, but was not likely to cause serious injury, impairment, or death; (3) Level 3 is a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death; and (4) Level 4 is a violation that results in serious injury, impairment, or death. Subd. 3. Scope of violations. Levels of violations are categorized by scope as follows:
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(1) isolated, when one or a limited number of residents are affected or one or a limited number of staff are involved or the situation has occurred only occasionally; (2) pattern, when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly but is not found to be pervasive; and (3) widespread, when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the residents. Subd. 4. Fine amounts. (a) Fines and enforcement actions under this subdivision may be assessed based on the level and scope of the violations described in subdivisions 2 and 3 as follows and may be imposed immediately with no opportunity to correct the violation prior to imposition: (1) Level 1, no fines or enforcement; (2) Level 2, a fine of $500 per violation, in addition to any enforcement mechanism authorized in section 144G.20 for widespread violations; (3) Level 3, a fine of $3,000 per violation per incident, in addition to any enforcement mechanism authorized in section 144G.20; (4) Level 4, a fine of $5,000 per incident, in addition to any enforcement mechanism authorized in section 144G.20; and (5) for maltreatment violations for which the licensee was determined to be responsible for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000. A fine of $5,000 may be imposed if the commissioner determines the licensee is responsible for maltreatment consisting of sexual assault, death, or abuse resulting in serious injury. (b) When a fine is assessed against a facility for substantiated maltreatment, the commissioner shall not also impose an immediate fine under this chapter for the same circumstance. Subd. 5. Immediate fine; payment. (a) For every Level 3 or Level 4 violation, the commissioner may issue an immediate fine. The licensee must still correct the violation in the time specified. The issuance of an immediate fine may occur in addition to any enforcement mechanism authorized under section 144G.20. The immediate fine may be appealed as allowed under this chapter. (b) The licensee must pay the fines assessed on or before the payment date specified. If the licensee fails to fully comply with the order, the commissioner may issue a second fine or suspend the license until the licensee complies by paying the fine. A timely appeal shall stay payment of the fine until the commissioner issues a final order. (c) A licensee shall promptly notify the commissioner in writing when a violation specified in the order is corrected. If upon reinspection the commissioner determines that a violation has not been corrected as indicated by the order, the commissioner may issue an additional fine. The commissioner shall notify the licensee by mail to the last known address in the licensing record that a second fine has been assessed. The licensee may appeal the second fine as provided under this subdivision. (d) A facility that has been assessed a fine under this section has a right to a reconsideration or hearing under this chapter and chapter 14.
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Subd. 6. Payment of fines required. When a fine has been assessed, the licensee may not avoid payment by closing, selling, or otherwise transferring the license to a third party. In such an event, the licensee shall be liable for payment of the fine. Subd. 7. Additional penalties. In addition to any fine imposed under this section, the commissioner may assess a penalty amount based on costs related to an investigation that results in a final order assessing a fine or other enforcement action authorized by this chapter. Subd. 8. Deposit of fines. Fines collected under this section shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner for special projects to improve home care in Minnesota as recommended by the advisory council established in section 144A.4799. History: 2019 c 60 art 1 s 36,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 36, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 36, the effective date. 144G.32 RECONSIDERATION OF CORRECTION ORDERS AND FINES. Subdivision 1. Reconsideration process required. The commissioner shall make available to assisted living facilities a correction order reconsideration process. This process may be used to challenge the correction order issued, including the level and scope described in section 144G.31, and any fine assessed. When a licensee requests reconsideration of a correction order, the correction order is not stayed while it is under reconsideration. The commissioner shall post information on its website that the licensee requested reconsideration of the correction order and that the review is pending. Subd. 2. Reconsideration process. An assisted living facility may request from the commissioner, in writing, a correction order reconsideration regarding any correction order issued to the facility. The written request for reconsideration must be received by the commissioner within 15 calendar days of the correction order receipt date. The correction order reconsideration shall not be reviewed by any surveyor, investigator, or supervisor that participated in writing or reviewing the correction order being disputed. The correction order reconsiderations may be conducted in person, by telephone, by another electronic form, or in writing, as determined by the commissioner. The commissioner shall respond in writing to the request from a facility for a correction order reconsideration within 60 days of the date the facility requests a reconsideration. The commissioner's response shall identify the commissioner's decision regarding each citation challenged by the facility. Subd. 3. Findings. The findings of a correction order reconsideration process shall be one or more of the following: (1) supported in full: the correction order is supported in full, with no deletion of findings to the citation; (2) supported in substance: the correction order is supported, but one or more findings are deleted or modified without any change in the citation; (3) correction order cited an incorrect licensing requirement: the correction order is amended by changing the correction order to the appropriate statute or rule; (4) correction order was issued under an incorrect citation: the correction order is amended to be issued under the more appropriate correction order citation; (5) the correction order is rescinded;
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(6) fine is amended: it is determined that the fine assigned to the correction order was applied incorrectly; or (7) the level or scope of the citation is modified based on the reconsideration. Subd. 4. Updating the correction order website. If the correction order findings are changed by the commissioner, the commissioner shall update the correction order website. Subd. 5. Exception; provisional licensees. This section does not apply to provisional licensees. History: 2019 c 60 art 1 s 37,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 37, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 37, the effective date. 144G.33 INNOVATION VARIANCE. Subdivision 1. Definition; granting variances. (a) For purposes of this section, "innovation variance" means a specified alternative to a requirement of this chapter. (b) An innovation variance may be granted to allow an assisted living facility to offer services of a type or in a manner that is innovative, will not impair the services provided, will not adversely affect the health, safety, or welfare of the residents, and is likely to improve the services provided. The innovative variance cannot change any of the resident's rights under the assisted living bill of rights. Subd. 2. Conditions. The commissioner may impose conditions on granting an innovation variance that the commissioner considers necessary. Subd. 3. Duration and renewal. The commissioner may limit the duration of any innovation variance and may renew a limited innovation variance. Subd. 4. Applications; innovation variance. An application for innovation variance from the requirements of this chapter may be made at any time, must be made in writing to the commissioner, and must specify the following: (1) the statute or rule from which the innovation variance is requested; (2) the time period for which the innovation variance is requested; (3) the specific alternative action that the licensee proposes; (4) the reasons for the request; and (5) justification that an innovation variance will not impair the services provided, will not adversely affect the health, safety, or welfare of residents, and is likely to improve the services provided. The commissioner may require additional information from the facility before acting on the request. Subd. 5. Grants and denials. The commissioner shall grant or deny each request for an innovation variance in writing within 45 days of receipt of a complete request. Notice of a denial shall contain the reasons for the denial. The terms of a requested innovation variance may be modified upon agreement between the commissioner and the facility. Subd. 6. Violation of innovation variances. A failure to comply with the terms of an innovation variance shall be deemed to be a violation of this chapter.
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Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or deny renewal of an innovation variance if: (1) it is determined that the innovation variance is adversely affecting the health, safety, or welfare of the residents; (2) the facility has failed to comply with the terms of the innovation variance; (3) the facility notifies the commissioner in writing that it wishes to relinquish the innovation variance and be subject to the statute previously varied; or (4) the revocation or denial is required by a change in law. History: 2019 c 60 art 1 s 39,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 39, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 39, the effective date. OPERATIONS AND PHYSICAL PLANT REQUIREMENTS 144G.40 HOUSING AND SERVICES. Subdivision 1. Responsibility for housing and services. The facility is directly responsible to the resident for all housing and service-related matters provided, irrespective of a management contract. Housing and service-related matters include but are not limited to the handling of complaints, the provision of notices, and the initiation of any adverse action against the resident involving housing or services provided by the facility. Subd. 2. Uniform checklist disclosure of services. (a) All assisted living facilities must provide to prospective residents: (1) a disclosure of the categories of assisted living licenses available and the category of license held by the facility; (2) a written checklist listing all services permitted under the facility's license, identifying all services the facility offers to provide under the assisted living facility contract, and identifying all services allowed under the license that the facility does not provide; and (3) an oral explanation of the services offered under the contract. (b) The requirements of paragraph (a) must be completed prior to the execution of the assisted living contract. (c) The commissioner must, in consultation with all interested stakeholders, design the uniform checklist disclosure form for use as provided under paragraph (a). Subd. 3. Reservation of rights. Nothing in this chapter: (1) requires a resident to utilize any service provided by or through, or made available in, a facility; (2) prevents a facility from requiring, as a condition of the contract, that the resident pay for a package of services even if the resident does not choose to use all or some of the services in the package. For residents who are eligible for home and community-based waiver services under chapter 256S and section 256B.49, payment for services will follow the policies of those programs;
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(3) requires a facility to fundamentally alter the nature of the operations of the facility in order to accommodate a resident's request; or (4) affects the duty of a facility to grant a resident's request for reasonable accommodations. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 13,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 13, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 13, the effective date. 144G.401 PAYMENT FOR SERVICES UNDER DISABILITY WAIVERS. For new assisted living facilities that did not operate as registered housing with services establishments prior to August 1, 2021, home and community-based services under section 256B.49 are not available when the new facility setting is adjoined to, or on the same property as, an institution as defined in Code of Federal Regulations, title 42, section 441.301(c). History: 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, subdivision 9, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.41 MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS. Subdivision 1. Minimum requirements. All assisted living facilities shall: (1) distribute to residents the assisted living bill of rights; (2) provide services in a manner that complies with the Nurse Practice Act in sections 148.171 to 148.285; (3) utilize a person-centered planning and service delivery process; (4) have and maintain a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by the Nurse Practice Act in sections 148.171 to 148.285; (5) provide a means for residents to request assistance for health and safety needs 24 hours per day, seven days per week; (6) allow residents the ability to furnish and decorate the resident's unit within the terms of the assisted living contract; (7) permit residents access to food at any time; (8) allow residents to choose the resident's visitors and times of visits; (9) allow the resident the right to choose a roommate if sharing a unit; (10) notify the resident of the resident's right to have and use a lockable door to the resident's unit. The licensee shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible. An assisted living facility must not lock a resident in the resident's unit; (11) develop and implement a staffing plan for determining its staffing level that:
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(i) includes an evaluation, to be conducted at least twice a year, of the appropriateness of staffing levels in the facility; (ii) ensures sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled needs of each resident as required by the residents' assessments and service plans on a 24-hour per day basis; and (iii) ensures that the facility can respond promptly and effectively to individual resident emergencies and to emergency, life safety, and disaster situations affecting staff or residents in the facility; (12) ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time; (iii) capable of communicating with residents; (iv) capable of providing or summoning the appropriate assistance; and (v) capable of following directions; and (13) offer to provide or make available at least the following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. The following apply: (A) menus must be prepared at least one week in advance, and made available to all residents. The facility must encourage residents' involvement in menu planning. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes; (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and (C) the facility cannot require a resident to include and pay for meals in their contract; (ii) weekly housekeeping; (iii) weekly laundry service; (iv) upon the request of the resident, provide direct or reasonable assistance with arranging for transportation to medical and social services appointments, shopping, and other recreation, and provide the name of or other identifying information about the persons responsible for providing this assistance; (v) upon the request of the resident, provide reasonable assistance with accessing community resources and social services available in the community, and provide the name of or other identifying information about persons responsible for providing this assistance; (vi) provide culturally sensitive programs; and
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(vii) have a daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs, and that creates opportunities for active participation in the community at large. Subd. 2. Policies and procedures. Each assisted living facility must have policies and procedures in place to address the following and keep them current: (1) requirements in section 626.557, reporting of maltreatment of vulnerable adults; (2) conducting and handling background studies on employees; (3) orientation, training, and competency evaluations of staff, and a process for evaluating staff performance; (4) handling complaints regarding staff or services provided by staff; (5) conducting initial evaluations of residents' needs and the providers' ability to provide those services; (6) conducting initial and ongoing resident evaluations and assessments of resident needs, including assessments by a registered nurse or appropriate licensed health professional, and how changes in a resident's condition are identified, managed, and communicated to staff and other health care providers as appropriate; (7) orientation to and implementation of the assisted living bill of rights; (8) infection control practices; (9) reminders for medications, treatments, or exercises, if provided; (10) conducting appropriate screenings, or documentation of prior screenings, to show that staff are free of tuberculosis, consistent with current United States Centers for Disease Control and Prevention standards; (11) ensuring that nurses and licensed health professionals have current and valid licenses to practice; (12) medication and treatment management; (13) delegation of tasks by registered nurses or licensed health professionals; (14) supervision of registered nurses and licensed health professionals; and (15) supervision of unlicensed personnel performing delegated tasks. Subd. 3. Infection control program. All assisted living facilities must establish and maintain an infection control program. Subd. 4. Clinical nurse supervision. All assisted living facilities must have a clinical nurse supervisor who is a registered nurse licensed in Minnesota. Subd. 5. Resident councils. The facility must provide a resident council with space and privacy for meetings, where doing so is reasonably achievable. Staff, visitors, and other guests may attend a resident council meeting only at the council's invitation. The facility must designate a staff person who is approved by the resident council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the resident council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the resident council, take reasonably achievable steps to make residents aware of upcoming meetings in a timely manner.
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Subd. 6. Family councils. The facility must provide a family council with space and privacy for meetings, where doing so is reasonably achievable. The facility must designate a staff person who is approved by the family council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the family council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the family council, take reasonably achievable steps to make residents and family members aware of upcoming meetings in a timely manner. Subd. 7. Resident grievances; reporting maltreatment. All facilities must post in a conspicuous place information about the facilities' grievance procedure, and the name, telephone number, and e-mail contact information for the individuals who are responsible for handling resident grievances. The notice must also have the contact information for the state and applicable regional Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities, and must have information for reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center. Subd. 8. Protecting resident rights. All facilities shall ensure that every resident has access to consumer advocacy or legal services by: (1) providing names and contact information, including telephone numbers and e-mail addresses of at least three organizations that provide advocacy or legal services to residents; (2) providing the name and contact information for the Minnesota Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities, including both the state and regional contact information; (3) assisting residents in obtaining information on whether Medicare or medical assistance under chapter 256B will pay for services; (4) making reasonable accommodations for people who have communication disabilities and those who speak a language other than English; and (5) providing all information and notices in plain language and in terms the residents can understand. History: 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.42 BUSINESS OPERATION. Subdivision 1. Display of license. The original current license must be displayed at the main entrance of each assisted living facility. The facility must provide a copy of the license to any person who requests it. Subd. 2. Quality management. The facility shall engage in quality management appropriate to the size of the facility and relevant to the type of services provided. "Quality management activity" means evaluating the quality of care by periodically reviewing resident services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to residents. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal.
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Subd. 3. Facility restrictions. (a) This subdivision does not apply to licensees that are Minnesota counties or other units of government. (b) A facility or staff person may not: (1) accept a power-of-attorney from residents for any purpose, and may not accept appointments as guardians or conservators of residents; or (2) borrow a resident's funds or personal or real property, nor in any way convert a resident's property to the possession of the facility or staff person. (c) A facility may not serve as a resident's legal, designated, or other representative. (d) Nothing in this subdivision precludes a facility or staff person from accepting gifts of minimal value or precludes acceptance of donations or bequests made to a facility that are exempt from section 501(c)(3) of the Internal Revenue Code. Subd. 4. Handling residents' finances and property. (a) A facility may assist residents with household budgeting, including paying bills and purchasing household goods, but may not otherwise manage a resident's property. (b) Where funds are deposited with the facility by the resident, the licensee: (1) retains fiduciary and custodial responsibility for the funds; (2) is directly accountable to the resident for the funds; and (3) must maintain records of and provide a resident with receipts for all transactions and purchases made with the resident's funds. When receipts are not available, the transaction or purchase must be documented. (c) Subject to paragraph (d), if responsibilities for day-to-day management of the resident funds are delegated to the manager, the manager must: (1) provide the licensee with a monthly accounting of the resident funds; and (2) meet all legal requirements related to holding and accounting for resident funds. (d) The facility must ensure any party responsible for holding or managing residents' personal funds is bonded or obtains insurance in sufficient amounts to specifically cover losses of resident funds and provides proof of the bond or insurance. Subd. 5. Final accounting; return of money and property. Within 30 days of the effective date of a facility-initiated or resident-initiated termination of housing or services or the death of the resident, the facility must: (1) provide to the resident, resident's legal representative, and resident's designated representative a final statement of account; (2) provide any refunds due; (3) return any money, property, or valuables held in trust or custody by the facility; and (4) as required under section 504B.178, refund the resident's security deposit unless it is applied to the first month's charges.
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Subd. 6. Compliance with requirements for reporting maltreatment of vulnerable adults; abuse prevention plan. (a) The assisted living facility must comply with the requirements for the reporting of maltreatment of vulnerable adults in section 626.557. The facility must establish and implement a written procedure to ensure that all cases of suspected maltreatment are reported. (b) The facility must develop and implement an individual abuse prevention plan for each vulnerable adult. The plan shall contain an individualized review or assessment of the person's susceptibility to abuse by another individual, including other vulnerable adults; the person's risk of abusing other vulnerable adults; and statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults. For purposes of the abuse prevention plan, abuse includes self-abuse. Subd. 7. Posting information for reporting suspected crime and maltreatment. The facility shall support protection and safety through access to the state's systems for reporting suspected criminal activity and suspected vulnerable adult maltreatment by: (1) posting the 911 emergency number in common areas and near telephones provided by the assisted living facility; (2) posting information and the reporting number for the Minnesota Adult Abuse Reporting Center to report suspected maltreatment of a vulnerable adult under section 626.557; and (3) providing reasonable accommodations with information and notices in plain language. Subd. 8. Employee records. (a) The facility must maintain current records of each paid employee, each regularly scheduled volunteer providing services, and each individual contractor providing services. The records must include the following information: (1) evidence of current professional licensure, registration, or certification if licensure, registration, or certification is required by this chapter or rules; (2) records of orientation, required annual training and infection control training, and competency evaluations; (3) current job description, including qualifications, responsibilities, and identification of staff persons providing supervision; (4) documentation of annual performance reviews that identify areas of improvement needed and training needs; (5) for individuals providing assisted living services, verification that required health screenings under subdivision 9 have taken place and the dates of those screenings; and (6) documentation of the background study as required under section 144.057. (b) Each employee record must be retained for at least three years after a paid employee, volunteer, or contractor ceases to be employed by, provide services at, or be under contract with the facility. If a facility ceases operation, employee records must be maintained for three years after facility operations cease. Subd. 9. Tuberculosis prevention and control. The facility must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in the CDC's Morbidity and Mortality Weekly Report (MMWR). The program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors,
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students, and regularly scheduled volunteers. The commissioner shall provide technical assistance regarding implementation of the guidelines. Subd. 10. Disaster planning and emergency preparedness plan. (a) The facility must meet the following requirements: (1) have a written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency; (2) post an emergency disaster plan prominently; (3) provide building emergency exit diagrams to all residents; (4) post emergency exit diagrams on each floor; and (5) have a written policy and procedure regarding missing tenant residents. (b) The facility must provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter and must make emergency and disaster training annually available to all residents. Staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on site. (c) The facility must meet any additional requirements adopted in rule. History: 2019 c 60 art 1 s 15,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 15, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 15, the effective date. 144G.43 RESIDENT RECORD REQUIREMENTS. Subdivision 1. Resident record. (a) Assisted living facilities must maintain records for each resident for whom it is providing services. Entries in the resident records must be current, legible, permanently recorded, dated, and authenticated with the name and title of the person making the entry. (b) Resident records, whether written or electronic, must be protected against loss, tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable relevant federal and state laws. The facility shall establish and implement written procedures to control use, storage, and security of resident records and establish criteria for release of resident information. (c) The facility may not disclose to any other person any personal, financial, or medical information about the resident, except: (1) as may be required by law; (2) to employees or contractors of the facility, another facility, other health care practitioner or provider, or inpatient facility needing information in order to provide services to the resident, but only the information that is necessary for the provision of services; (3) to persons authorized in writing by the resident, including third-party payers; and (4) to representatives of the commissioner authorized to survey or investigate facilities under this chapter or federal laws.
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Subd. 2. Access to records. The facility must ensure that the appropriate records are readily available to employees and contractors authorized to access the records. Resident records must be maintained in a manner that allows for timely access, printing, or transmission of the records. The records must be made readily available to the commissioner upon request. Subd. 3. Contents of resident record. Contents of a resident record include the following for each resident: (1) identifying information, including the resident's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of the resident's emergency contact, legal representatives, and designated representative; (3) names, addresses, and telephone numbers of the resident's health and medical service providers, if known; (4) health information, including medical history, allergies, and when the provider is managing medications, treatments or therapies that require documentation, and other relevant health records; (5) the resident's advance directives, if any; (6) copies of any health care directives, guardianships, powers of attorney, or conservatorships; (7) the facility's current and previous assessments and service plans; (8) all records of communications pertinent to the resident's services; (9) documentation of significant changes in the resident's status and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (10) documentation of incidents involving the resident and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (11) documentation that services have been provided as identified in the service plan; (12) documentation that the resident has received and reviewed the assisted living bill of rights; (13) documentation of complaints received and any resolution; (14) a discharge summary, including service termination notice and related documentation, when applicable; and (15) other documentation required under this chapter and relevant to the resident's services or status. Subd. 4. Transfer of resident records. With the resident's knowledge and consent, if a resident is relocated to another facility or to a nursing home, or if care is transferred to another service provider, the facility must timely convey to the new facility, nursing home, or provider: (1) the resident's full name, date of birth, and insurance information; (2) the name, telephone number, and address of the resident's designated representatives and legal representatives, if any; (3) the resident's current documented diagnoses that are relevant to the services being provided; (4) the resident's known allergies that are relevant to the services being provided;
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(5) the name and telephone number of the resident's physician, if known, and the current physician orders that are relevant to the services being provided; (6) all medication administration records that are relevant to the services being provided; (7) the most recent resident assessment, if relevant to the services being provided; and (8) copies of health care directives, "do not resuscitate" orders, and any guardianship orders or powers of attorney. Subd. 5. Record retention. Following the resident's discharge or termination of services, an assisted living facility must retain a resident's record for at least five years or as otherwise required by state or federal regulations. Arrangements must be made for secure storage and retrieval of resident records if the facility ceases to operate. History: 2019 c 60 art 1 s 21,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 21, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 21, the effective date. 144G.45 MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS. Subdivision 1. Requirements. The following are required for all assisted living facilities: (1) public utilities must be available, and working or inspected and approved water and septic systems must be in place; (2) the location must be publicly accessible to fire department services and emergency medical services; (3) the location's topography must provide sufficient natural drainage and is not subject to flooding; (4) all-weather roads and walks must be provided within the lot lines to the primary entrance and the service entrance, including employees' and visitors' parking at the site; and (5) the location must include space for outdoor activities for residents. Subd. 2. Fire protection and physical environment. (a) Each assisted living facility must have a comprehensive fire protection system that includes: (1) protection throughout by an approved supervised automatic sprinkler system according to building code requirements established in Minnesota Rules, part 1305.0903, or smoke detectors in each occupied room installed and maintained in accordance with the National Fire Protection Association (NFPA) Standard 72; (2) portable fire extinguishers installed and tested in accordance with the NFPA Standard 10; and (3) the physical environment, including walls, floors, ceiling, all furnishings, grounds, systems, and equipment that is kept in a continuous state of good repair and operation with regard to the health, safety, comfort, and well-being of the residents in accordance with a maintenance and repair program. (b) Fire drills in assisted living facilities shall be conducted in accordance with the residential board and care requirements in the Life Safety Code, except that fire drills in secured dementia care units shall be conducted in accordance with section 144G.81, subdivision 2.
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(c) Existing construction or elements, including assisted living facilities that were registered as housing with services establishments under chapter 144D prior to August 1, 2021, shall be permitted to be continued in use provided such use does not constitute a distinct hazard to life. Any existing elements that an authority having jurisdiction deems a distinct hazard to life must be corrected. The facility must document in the facility's records any actions taken to comply with a correction order, and must submit to the commissioner for review and approval prior to correction. Subd. 3. Local laws apply. Assisted living facilities shall comply with all applicable state and local governing laws, regulations, standards, ordinances, and codes for fire safety, building, and zoning requirements. Subd. 4. Design requirements. (a) All assisted living facilities with six or more residents must meet the provisions relevant to assisted living facilities in the most current edition of the Facility Guidelines Institute "Guidelines for Design and Construction of Residential Health, Care and Support Facilities" and of adopted rules. This minimum design standard must be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. In addition to the guidelines, assisted living facilities shall provide the option of a bath in addition to a shower for all residents. (b) If the commissioner decides to update the edition of the guidelines specified in paragraph (a) for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new edition will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which facilities must comply with the updated edition. The date by which facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 5. Assisted living facilities; Life Safety Code. (a) All assisted living facilities with six or more residents must meet the applicable provisions of the most current edition of the NFPA Standard 101, Life Safety Code, Residential Board and Care Occupancies chapter. The minimum design standard shall be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. (b) If the commissioner decides to update the Life Safety Code for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new Life Safety Code will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which facilities must comply with the updated Life Safety Code. The date by which facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 6. New construction; plans. (a) For all new licensure and construction beginning on or after August 1, 2021, the following must be provided to the commissioner: (1) architectural and engineering plans and specifications for new construction must be prepared and signed by architects and engineers who are registered in Minnesota. Final working drawings and specifications for proposed construction must be submitted to the commissioner for review and approval; (2) final architectural plans and specifications must include elevations and sections through the building showing types of construction, and must indicate dimensions and assignments of rooms and areas, room
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finishes, door types and hardware, elevations and details of nurses' work areas, utility rooms, toilet and bathing areas, and large-scale layouts of dietary and laundry areas. Plans must show the location of fixed equipment and sections and details of elevators, chutes, and other conveying systems. Fire walls and smoke partitions must be indicated. The roof plan must show all mechanical installations. The site plan must indicate the proposed and existing buildings, topography, roadways, walks and utility service lines; and (3) final mechanical and electrical plans and specifications must address the complete layout and type of all installations, systems, and equipment to be provided. Heating plans must include heating elements, piping, thermostatic controls, pumps, tanks, heat exchangers, boilers, breeching, and accessories. Ventilation plans must include room air quantities, ducts, fire and smoke dampers, exhaust fans, humidifiers, and air handling units. Plumbing plans must include the fixtures and equipment fixture schedule; water supply and circulating piping, pumps, tanks, riser diagrams, and building drains; the size, location, and elevation of water and sewer services; and the building fire protection systems. Electrical plans must include fixtures and equipment, receptacles, switches, power outlets, circuits, power and light panels, transformers, and service feeders. Plans must show location of nurse call signals, cable lines, fire alarm stations, and fire detectors and emergency lighting. (b) Unless construction is begun within one year after approval of the final working drawing and specifications, the drawings must be resubmitted for review and approval. (c) The commissioner must be notified within 30 days before completion of construction so that the commissioner can make arrangements for a final inspection by the commissioner. (d) At least one set of complete life safety plans, including changes resulting from remodeling or alterations, must be kept on file in the facility. Subd. 7. Variance or waiver. (a) A facility may request that the commissioner grant a variance or waiver from the provisions of this section or section 144G.81, subdivision 5. A request for a waiver must be submitted to the commissioner in writing. Each request must contain: (1) the specific requirement for which the variance or waiver is requested; (2) the reasons for the request; (3) the alternative measures that will be taken if a variance or waiver is granted; (4) the length of time for which the variance or waiver is requested; and (5) other relevant information deemed necessary by the commissioner to properly evaluate the request for the waiver. (b) The decision to grant or deny a variance or waiver must be based on the commissioner's evaluation of the following criteria: (1) whether the waiver will adversely affect the health, treatment, comfort, safety, or well-being of a resident; (2) whether the alternative measures to be taken, if any, are equivalent to or superior to those permitted under section 144G.81, subdivision 5; and (3) whether compliance with the requirements would impose an undue burden on the facility.
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(c) The commissioner must notify the facility in writing of the decision. If a variance or waiver is granted, the notification must specify the period of time for which the variance or waiver is effective and the alternative measures or conditions, if any, to be met by the facility. (d) Alternative measures or conditions attached to a variance or waiver have the force and effect of this chapter and are subject to the issuance of correction orders and fines in accordance with sections 144G.30, subdivision 7, and 144G.31. The amount of fines for a violation of this subdivision is that specified for the specific requirement for which the variance or waiver was requested. (e) A request for renewal of a variance or waiver must be submitted in writing at least 45 days before its expiration date. Renewal requests must contain the information specified in paragraph (b). A variance or waiver must be renewed by the commissioner if the facility continues to satisfy the criteria in paragraph (a) and demonstrates compliance with the alternative measures or conditions imposed at the time the original variance or waiver was granted. (f) The commissioner must deny, revoke, or refuse to renew a variance or waiver if it is determined that the criteria in paragraph (a) are not met. The facility must be notified in writing of the reasons for the decision and informed of the right to appeal the decision. (g) A facility may contest the denial, revocation, or refusal to renew a variance or waiver by requesting a contested case hearing under chapter 14. The facility must submit, within 15 days of the receipt of the commissioner's decision, a written request for a hearing. The request for hearing must set forth in detail the reasons why the facility contends the decision of the commissioner should be reversed or modified. At the hearing, the facility has the burden of proving by a preponderance of the evidence that the facility satisfied the criteria specified in paragraph (b), except in a proceeding challenging the revocation of a variance or waiver. History: 2019 c 60 art 1 s 25,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 25, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 25, the effective date. CONTRACTS, TERMINATIONS, AND RELOCATIONS 144G.50 ASSISTED LIVING CONTRACT REQUIREMENTS. Subdivision 1. Contract required. (a) An assisted living facility may not offer or provide housing or assisted living services to a resident unless it has executed a written contract with the resident. (b) The contract must contain all the terms concerning the provision of: (1) housing; (2) assisted living services, whether provided directly by the facility or by management agreement or other agreement; and (3) the resident's service plan, if applicable. (c) A facility must: (1) offer to prospective residents and provide to the Office of Ombudsman for Long-Term Care a complete unsigned copy of its contract; and
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(2) give a complete copy of any signed contract and any addendums, and all supporting documents and attachments, to the resident promptly after a contract and any addendum has been signed. (d) A contract under this section is a consumer contract under sections 325G.29 to 325G.37. (e) Before or at the time of execution of the contract, the facility must offer the resident the opportunity to identify a designated representative according to subdivision 3. (f) The resident must agree in writing to any additions or amendments to the contract. Upon agreement between the resident and the facility, a new contract or an addendum to the existing contract must be executed and signed. Subd. 2. Contract information. (a) The contract must include in a conspicuous place and manner on the contract the legal name and the license number of the facility. (b) The contract must include the name, telephone number, and physical mailing address, which may not be a public or private post office box, of: (1) the facility and contracted service provider when applicable; (2) the licensee of the facility; (3) the managing agent of the facility, if applicable; and (4) the authorized agent for the facility. (c) The contract must include: (1) a disclosure of the category of assisted living facility license held by the facility and, if the facility is not an assisted living facility with dementia care, a disclosure that it does not hold an assisted living facility with dementia care license; (2) a description of all the terms and conditions of the contract, including a description of and any limitations to the housing or assisted living services to be provided for the contracted amount; (3) a delineation of the cost and nature of any other services to be provided for an additional fee; (4) a delineation and description of any additional fees the resident may be required to pay if the resident's condition changes during the term of the contract; (5) a delineation of the grounds under which the resident may be discharged, evicted, or transferred or have services terminated; (6) billing and payment procedures and requirements; and (7) disclosure of the facility's ability to provide specialized diets. (d) The contract must include a description of the facility's complaint resolution process available to residents, including the name and contact information of the person representing the facility who is designated to handle and resolve complaints. (e) The contract must include a clear and conspicuous notice of: (1) the right under section 144G.54 to appeal the termination of an assisted living contract;
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(2) the facility's policy regarding transfer of residents within the facility, under what circumstances a transfer may occur, and the circumstances under which resident consent is required for a transfer; (3) contact information for the Office of Ombudsman for Long-Term Care, the Ombudsman for Mental Health and Developmental Disabilities, and the Office of Health Facility Complaints; (4) the resident's right to obtain services from an unaffiliated service provider; (5) a description of the facility's policies related to medical assistance waivers under chapter 256S and section 256B.49 and the housing support program under chapter 256I, including: (i) whether the facility is enrolled with the commissioner of human services to provide customized living services under medical assistance waivers; (ii) whether the facility has an agreement to provide housing support under section 256I.04, subdivision 2, paragraph (b); (iii) whether there is a limit on the number of people residing at the facility who can receive customized living services or participate in the housing support program at any point in time. If so, the limit must be provided; (iv) whether the facility requires a resident to pay privately for a period of time prior to accepting payment under medical assistance waivers or the housing support program, and if so, the length of time that private payment is required; (v) a statement that medical assistance waivers provide payment for services, but do not cover the cost of rent; (vi) a statement that residents may be eligible for assistance with rent through the housing support program; and (vii) a description of the rent requirements for people who are eligible for medical assistance waivers but who are not eligible for assistance through the housing support program; (6) the contact information to obtain long-term care consulting services under section 256B.0911; and (7) the toll-free phone number for the Minnesota Adult Abuse Reporting Center. Subd. 3. Designation of representative. (a) Before or at the time of execution of an assisted living contract, an assisted living facility must offer the resident the opportunity to identify a designated representative in writing in the contract and must provide the following verbatim notice on a document separate from the contract: "RIGHT TO DESIGNATE A REPRESENTATIVE FOR CERTAIN PURPOSES. You have the right to name anyone as your "Designated Representative." A Designated Representative can assist you, receive certain information and notices about you, including some information related to your health care, and advocate on your behalf. A Designated Representative does not take the place of your guardian, conservator, power of attorney ("attorney-in-fact"), or health care power of attorney ("health care agent"), if applicable." (b) The contract must contain a page or space for the name and contact information of the designated representative and a box the resident must initial if the resident declines to name a designated representative.
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Notwithstanding subdivision 1, paragraph (f), the resident has the right at any time to add, remove, or change the name and contact information of the designated representative. Subd. 4. Filing. The contract and related documents must be maintained by the facility in files from the date of execution until five years after the contract is terminated or expires. The contracts and all associated documents must be available for on-site inspection by the commissioner at any time. The documents shall be available for viewing or copies shall be made available to the resident and the legal or designated representative at any time. Subd. 5. Waivers of liability prohibited. The contract must not include a waiver of facility liability for the health and safety or personal property of a resident. The contract must not include any provision that the facility knows or should know to be deceptive, unlawful, or unenforceable under state or federal law, nor include any provision that requires or implies a lesser standard of care or responsibility than is required by law. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 26,47; 2020 c 83 art 1 s 36 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 26, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 26, the effective date. 144G.51 ARBITRATION. (a) An assisted living facility must clearly and conspicuously disclose, in writing in an assisted living contract, any arbitration provision in the contract that precludes, limits, or delays the ability of a resident from taking a civil action. (b) An arbitration requirement must not include a choice of law or choice of venue provision. Assisted living contracts must adhere to Minnesota law and any other applicable federal or local law. History: 2019 c 60 art 1 s 31,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 31, is effective August 1, 2021, for contracts entered into on or after that date. Laws 2019, chapter 60, article 1, section 31, the effective date. 144G.52 ASSISTED LIVING CONTRACT TERMINATIONS. Subdivision 1. Definition. For purposes of sections 144G.52 to 144G.55, "termination" means: (1) a facility-initiated termination of housing provided to the resident under the contract; or (2) a facility-initiated termination or nonrenewal of all assisted living services the resident receives from the facility under the contract. Subd. 2. Prerequisite to termination of a contract. (a) Before issuing a notice of termination of an assisted living contract, a facility must schedule and participate in a meeting with the resident and the resident's legal representative and designated representative. The purposes of the meeting are to: (1) explain in detail the reasons for the proposed termination; and (2) identify and offer reasonable accommodations or modifications, interventions, or alternatives to avoid the termination or enable the resident to remain in the facility, including but not limited to securing services from another provider of the resident's choosing that may allow the resident to avoid the termination.
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A facility is not required to offer accommodations, modifications, interventions, or alternatives that fundamentally alter the nature of the operation of the facility. (b) The meeting must be scheduled to take place at least seven days before a notice of termination is issued. The facility must make reasonable efforts to ensure that the resident, legal representative, and designated representative are able to attend the meeting. (c) The facility must notify the resident that the resident may invite family members, relevant health professionals, a representative of the Office of Ombudsman for Long-Term Care, or other persons of the resident's choosing to participate in the meeting. For residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the facility must notify the resident's case manager of the meeting. (d) In the event of an emergency relocation under subdivision 9, where the facility intends to issue a notice of termination and an in-person meeting is impractical or impossible, the facility may attempt to schedule and participate in a meeting under this subdivision via telephone, video, or other means. Subd. 3. Termination for nonpayment. (a) A facility may initiate a termination of housing because of nonpayment of rent or a termination of services because of nonpayment for services. Upon issuance of a notice of termination for nonpayment, the facility must inform the resident that public benefits may be available and must provide contact information for the Senior LinkAge Line under section 256.975, subdivision 7. (b) An interruption to a resident's public benefits that lasts for no more than 60 days does not constitute nonpayment. Subd. 4. Termination for violation of the assisted living contract. A facility may initiate a termination of the assisted living contract if the resident violates a lawful provision of the contract and the resident does not cure the violation within a reasonable amount of time after the facility provides written notice of the ability to cure to the resident. Written notice of the ability to cure may be provided in person or by first class mail. A facility is not required to provide a resident with written notice of the ability to cure for a violation that threatens the health or safety of the resident or another individual in the facility, or for a violation that constitutes illegal conduct. Subd. 5. Expedited termination. (a) A facility may initiate an expedited termination of housing or services if: (1) the resident has engaged in conduct that substantially interferes with the rights, health, or safety of other residents; (2) the resident has engaged in conduct that substantially and intentionally interferes with the safety or physical health of facility staff; or (3) the resident has committed an act listed in section 504B.171 that substantially interferes with the rights, health, or safety of other residents. (b) A facility may initiate an expedited termination of services if: (1) the resident has engaged in conduct that substantially interferes with the resident's health or safety; (2) the resident's assessed needs exceed the scope of services agreed upon in the assisted living contract and are not included in the services the facility disclosed in the uniform checklist; or
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(3) extraordinary circumstances exist, causing the facility to be unable to provide the resident with the services disclosed in the uniform checklist that are necessary to meet the resident's needs. Subd. 6. Right to use provider of resident's choosing. A facility may not terminate the assisted living contract if the underlying reason for termination may be resolved by the resident obtaining services from another provider of the resident's choosing and the resident obtains those services. Subd. 7. Notice of contract termination required. (a) A facility terminating a contract must issue a written notice of termination according to this section. The facility must also send a copy of the termination notice to the Office of Ombudsman for Long-Term Care and, for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, to the resident's case manager, as soon as practicable after providing notice to the resident. A facility may terminate an assisted living contract only as permitted under subdivisions 3, 4, and 5. (b) A facility terminating a contract under subdivision 3 or 4 must provide a written termination notice at least 30 days before the effective date of the termination to the resident, legal representative, and designated representative. (c) A facility terminating a contract under subdivision 5 must provide a written termination notice at least 15 days before the effective date of the termination to the resident, legal representative, and designated representative. (d) If a resident moves out of a facility or cancels services received from the facility, nothing in this section prohibits a facility from enforcing against the resident any notice periods with which the resident must comply under the assisted living contract. Subd. 8. Content of notice of termination. The notice required under subdivision 7 must contain, at a minimum: (1) the effective date of the termination of the assisted living contract; (2) a detailed explanation of the basis for the termination, including the clinical or other supporting rationale; (3) a detailed explanation of the conditions under which a new or amended contract may be executed; (4) a statement that the resident has the right to appeal the termination by requesting a hearing, and information concerning the time frame within which the request must be submitted and the contact information for the agency to which the request must be submitted; (5) a statement that the facility must participate in a coordinated move to another provider or caregiver, as required under section 144G.55; (6) the name and contact information of the person employed by the facility with whom the resident may discuss the notice of termination; (7) information on how to contact the Office of Ombudsman for Long-Term Care to request an advocate to assist regarding the termination; (8) information on how to contact the Senior LinkAge Line under section 256.975, subdivision 7, and an explanation that the Senior LinkAge Line may provide information about other available housing or service options; and
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(9) if the termination is only for services, a statement that the resident may remain in the facility and may secure any necessary services from another provider of the resident's choosing. Subd. 9. Emergency relocation. (a) A facility may remove a resident from the facility in an emergency if necessary due to a resident's urgent medical needs or an imminent risk the resident poses to the health or safety of another facility resident or facility staff member. An emergency relocation is not a termination. (b) In the event of an emergency relocation, the facility must provide a written notice that contains, at a minimum: (1) the reason for the relocation; (2) the name and contact information for the location to which the resident has been relocated and any new service provider; (3) contact information for the Office of Ombudsman for Long-Term Care; (4) if known and applicable, the approximate date or range of dates within which the resident is expected to return to the facility, or a statement that a return date is not currently known; and (5) a statement that, if the facility refuses to provide housing or services after a relocation, the resident has the right to appeal under section 144G.54. The facility must provide contact information for the agency to which the resident may submit an appeal. (c) The notice required under paragraph (b) must be delivered as soon as practicable to: (1) the resident, legal representative, and designated representative; (2) for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the resident's case manager; and (3) the Office of Ombudsman for Long-Term Care if the resident has been relocated and has not returned to the facility within four days. (d) Following an emergency relocation, a facility's refusal to provide housing or services constitutes a termination and triggers the termination process in this section. Subd. 10. Right to return. If a resident is absent from a facility for any reason, including an emergency relocation, the facility shall not refuse to allow a resident to return if a termination of housing has not been effectuated. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 27,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 27, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 27, the effective date. 144G.53 NONRENEWAL OF HOUSING. (a) If a facility decides to not renew a resident's housing under a contract, the facility must either (1) provide the resident with 60 calendar days' notice of the nonrenewal and assistance with relocation planning, or (2) follow the termination procedure under section 144G.52. (b) The notice must include the reason for the nonrenewal and contact information of the Office of Ombudsman for Long-Term Care.
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(c) A facility must: (1) provide notice of the nonrenewal to the Office of Ombudsman for Long-Term Care; (2) for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, provide notice to the resident's case manager; (3) ensure a coordinated move to a safe location, as defined in section 144G.55, subdivision 2, that is appropriate for the resident; (4) ensure a coordinated move to an appropriate service provider identified by the facility, if services are still needed and desired by the resident; (5) consult and cooperate with the resident, legal representative, designated representative, case manager for a resident who receives home and community-based waiver services under chapter 256S and section 256B.49, relevant health professionals, and any other persons of the resident's choosing to make arrangements to move the resident, including consideration of the resident's goals; and (6) prepare a written plan to prepare for the move. (d) A resident may decline to move to the location the facility identifies or to accept services from a service provider the facility identifies, and may instead choose to move to a location of the resident's choosing or receive services from a service provider of the resident's choosing within the timeline prescribed in the nonrenewal notice. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 28,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 28, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 28, the effective date. 144G.54 APPEALS OF CONTRACT TERMINATIONS. Subdivision 1. Right to appeal. Residents have the right to appeal the termination of an assisted living contract. Subd. 2. Permissible grounds to appeal termination. A resident may appeal a termination initiated under section 144G.52, subdivision 3, 4, or 5, on the ground that: (1) there is a factual dispute as to whether the facility had a permissible basis to initiate the termination; (2) the termination would result in great harm or the potential for great harm to the resident as determined by the totality of the circumstances, except in circumstances where there is a greater risk of harm to other residents or staff at the facility; (3) the resident has cured or demonstrated the ability to cure the reasons for the termination, or has identified a reasonable accommodation or modification, intervention, or alternative to the termination; or (4) the facility has terminated the contract in violation of state or federal law. Subd. 3. Appeals process. (a) The Office of Administrative Hearings must conduct an expedited hearing as soon as practicable under this section, but in no event later than 14 calendar days after the office receives the request, unless the parties agree otherwise or the chief administrative law judge deems the timing to be unreasonable, given the complexity of the issues presented.
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(b) The hearing must be held at the facility where the resident lives, unless holding the hearing at that location is impractical, the parties agree to hold the hearing at a different location, or the chief administrative law judge grants a party's request to appear at another location or by telephone or interactive video. (c) The hearing is not a formal contested case proceeding, except when determined necessary by the chief administrative law judge. (d) Parties may but are not required to be represented by counsel. The appearance of a party without counsel does not constitute the unauthorized practice of law. (e) The hearing shall be limited to the amount of time necessary for the participants to expeditiously present the facts about the proposed termination. The administrative law judge shall issue a recommendation to the commissioner as soon as practicable, but in no event later than ten business days after the hearing. Subd. 4. Burden of proof for appeals of termination. (a) The facility bears the burden of proof to establish by a preponderance of the evidence that the termination was permissible if the appeal is brought on the ground listed in subdivision 2, clause (4). (b) The resident bears the burden of proof to establish by a preponderance of the evidence that the termination was permissible if the appeal is brought on the ground listed in subdivision 2, clause (2) or (3). Subd. 5. Determination; content of order. (a) The resident's termination must be rescinded if the resident prevails in the appeal. (b) The order may contain any conditions that may be placed on the resident's continued residency or receipt of services, including but not limited to changes to the service plan or a required increase in services. Subd. 6. Service provision while appeal pending. A termination of housing or services shall not occur while an appeal is pending. If additional services are needed to meet the health or safety needs of the resident while an appeal is pending, the resident is responsible for contracting for those additional services from the facility or another provider and for ensuring the costs for those additional services are covered. Subd. 7. Application of chapter 504B to appeals of terminations. A resident may not bring an action under chapter 504B to challenge a termination that has occurred and been upheld under this section. History: 2019 c 60 art 1 s 29,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 29, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 29, the effective date. 144G.55 COORDINATED MOVES. Subdivision 1. Duties of facility. (a) If a facility terminates an assisted living contract, reduces services to the extent that a resident needs to move, or conducts a planned closure under section 144G.57, the facility: (1) must ensure, subject to paragraph (c), a coordinated move to a safe location that is appropriate for the resident and that is identified by the facility prior to any hearing under section 144G.54; (2) must ensure a coordinated move of the resident to an appropriate service provider identified by the facility prior to any hearing under section 144G.54, provided services are still needed and desired by the resident; and (3) must consult and cooperate with the resident, legal representative, designated representative, case manager for a resident who receives home and community-based waiver services under chapter 256S and
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section 256B.49, relevant health professionals, and any other persons of the resident's choosing to make arrangements to move the resident, including consideration of the resident's goals. (b) A facility may satisfy the requirements of paragraph (a), clauses (1) and (2), by moving the resident to a different location within the same facility, if appropriate for the resident. (c) A resident may decline to move to the location the facility identifies or to accept services from a service provider the facility identifies, and may choose instead to move to a location of the resident's choosing or receive services from a service provider of the resident's choosing within the timeline prescribed in the termination notice. (d) Sixty days before the facility plans to reduce or eliminate one or more services for a particular resident, the facility must provide written notice of the reduction that includes: (1) a detailed explanation of the reasons for the reduction and the date of the reduction; (2) the contact information for the Office of Ombudsman for Long-Term Care and the name and contact information of the person employed by the facility with whom the resident may discuss the reduction of services; (3) a statement that if the services being reduced are still needed by the resident, the resident may remain in the facility and seek services from another provider; and (4) a statement that if the reduction makes the resident need to move, the facility must participate in a coordinated move of the resident to another provider or caregiver, as required under this section. (e) In the event of an unanticipated reduction in services caused by extraordinary circumstances, the facility must provide the notice required under paragraph (d) as soon as possible. (f) If the facility, a resident, a legal representative, or a designated representative determines that a reduction in services will make a resident need to move to a new location, the facility must ensure a coordinated move in accordance with this section, and must provide notice to the Office of Ombudsman for Long-Term Care. (g) Nothing in this section affects a resident's right to remain in the facility and seek services from another provider. Subd. 2. Safe location. A safe location is not a private home where the occupant is unwilling or unable to care for the resident, a homeless shelter, a hotel, or a motel. A facility may not terminate a resident's housing or services if the resident will, as the result of the termination, become homeless, as that term is defined in section 116L.361, subdivision 5, or if an adequate and safe discharge location or adequate and needed service provider has not been identified. This subdivision does not preclude a resident from declining to move to the location the facility identifies. Subd. 3. Relocation plan required. The facility must prepare a relocation plan to prepare for the move to the new location or service provider. Subd. 4. License restrictions. Unless otherwise ordered by the commissioner, if a facility's license is restricted by the commissioner under section 144G.20 such that a resident must move or obtain a new service provider, the facility must comply with this section.
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Subd. 5. No waiver. The rights established under this section for the benefit of residents do not limit any other rights available under other law. No facility may request or require that any resident waive the resident's rights at any time for any reason, including as a condition of admission to the facility. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 30,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 30, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 30, the effective date. 144G.56 TRANSFER OF RESIDENTS WITHIN FACILITY. Subdivision 1. Definition. For the purposes of this section, "transfer" means a move of a resident within the facility to a different room or other private living unit. Subd. 2. Orderly transfer. A facility must provide for the safe, orderly, coordinated, and appropriate transfer of residents within the facility. Subd. 3. Notice required. (a) A facility must provide at least 30 calendar days' advance written notice to the resident and the resident's legal and designated representative of a facility-initiated transfer. The notice must include: (1) the effective date of the proposed transfer; (2) the proposed transfer location; (3) a statement that the resident may refuse the proposed transfer, and may discuss any consequences of a refusal with staff of the facility; (4) the name and contact information of a person employed by the facility with whom the resident may discuss the notice of transfer; and (5) contact information for the Office of Ombudsman for Long-Term Care. (b) Notwithstanding paragraph (a), a facility may conduct a facility-initiated transfer of a resident with less than 30 days' written notice if the transfer is necessary due to: (1) conditions that render the resident's room or private living unit uninhabitable; (2) the resident's urgent medical needs; or (3) a risk to the health or safety of another resident of the facility. Subd. 4. Consent required. The facility may not transfer a resident without first obtaining the resident's consent to the transfer unless: (1) there are conditions that render the resident's room or private living unit uninhabitable; or (2) there is a change in facility operations as described in subdivision 5. Subd. 5. Changes in facility operations. (a) In situations where there is a curtailment, reduction, or capital improvement within a facility necessitating transfers, the facility must: (1) minimize the number of transfers it initiates to complete the project or change in operations; (2) consider individual resident needs and preferences;
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(3) provide reasonable accommodations for individual resident requests regarding the transfers; and (4) in advance of any notice to any residents, legal representatives, or designated representatives, provide notice to the Office of Ombudsman for Long-Term Care and, when appropriate, the Office of Ombudsman for Mental Health and Developmental Disabilities of the curtailment, reduction, or capital improvement and the corresponding needed transfers. Subd. 6. Evaluation. If a resident consents to a transfer, reasonable modifications must be made to the new room or private living unit that are necessary to accommodate the resident's disabilities. The facility must evaluate the resident's individual needs before deciding whether the room or unit to which the resident will be moved is appropriate to the resident's psychological, cognitive, and health care needs, including the accessibility of the bathroom. Subd. 7. Disclosure. When entering into the assisted living contract, the facility must provide a conspicuous notice of the circumstance under which the facility may require a transfer, including any transfer that may be required if the resident will be receiving housing support under section 256I.06. History: 2019 c 60 art 1 s 14,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 14, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 14, the effective date. 144G.57 PLANNED CLOSURES. Subdivision 1. Closure plan required. In the event that an assisted living facility elects to voluntarily close the facility, the facility must notify the commissioner and the Office of Ombudsman for Long-Term Care in writing by submitting a proposed closure plan. Subd. 2. Content of closure plan. The facility's proposed closure plan must include: (1) the procedures and actions the facility will implement to notify residents of the closure, including a copy of the written notice to be given to residents, designated representatives, legal representatives, and family and other resident contacts; (2) the procedures and actions the facility will implement to ensure all residents receive appropriate termination planning in accordance with section 144G.55, and final accountings and returns under section 144G.42, subdivision 5; (3) assessments of the needs and preferences of individual residents; and (4) procedures and actions the facility will implement to maintain compliance with this chapter until all residents have relocated. Subd. 3. Commissioner's approval required prior to implementation. (a) The plan shall be subject to the commissioner's approval and subdivision 6. The facility shall take no action to close the residence prior to the commissioner's approval of the plan. The commissioner shall approve or otherwise respond to the plan as soon as practicable. (b) The commissioner may require the facility to work with a transitional team comprised of department staff, staff of the Office of Ombudsman for Long-Term Care, and other professionals the commissioner deems necessary to assist in the proper relocation of residents.
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Subd. 4. Termination planning and final accounting requirements. Prior to termination, the facility must follow the termination planning requirements under section 144G.55, and final accounting and return requirements under section 144G.42, subdivision 5, for residents. The facility must implement the plan approved by the commissioner and ensure that arrangements for relocation and continued care that meet each resident's social, emotional, and health needs are effectuated prior to closure. Subd. 5. Notice to residents. After the commissioner has approved the relocation plan and at least 60 calendar days before closing, except as provided under subdivision 6, the facility must notify residents, designated representatives, and legal representatives of the closure, the proposed date of closure, the contact information of the ombudsman for long-term care, and that the facility will follow the termination planning requirements under section 144G.55, and final accounting and return requirements under section 144G.42, subdivision 5. For residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the facility must also provide this information to the resident's case manager. Subd. 6. Emergency closures. (a) In the event the facility must close because the commissioner deems the facility can no longer remain open, the facility must meet all requirements in subdivisions 1 to 5, except for any requirements the commissioner finds would endanger the health and safety of residents. In the event the commissioner determines a closure must occur with less than 60 calendar days' notice, the facility shall provide notice to residents as soon as practicable or as directed by the commissioner. (b) Upon request from the commissioner, the facility must provide the commissioner with any documentation related to the appropriateness of its relocation plan, or to any assertion that the facility lacks the funds to comply with subdivisions 1 to 5, or that remaining open would otherwise endanger the health and safety of residents pursuant to paragraph (a). Subd. 7. Other rights. Nothing in this section affects the rights and remedies available under chapter 504B. Subd. 8. Fine. The commissioner may impose a fine for failure to follow the requirements of this section. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 33,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 33, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 33, the effective date. STAFFING REQUIREMENTS 144G.60 STAFFING REQUIREMENTS. Subdivision 1. Background studies required. (a) Employees, contractors, and regularly scheduled volunteers of the facility are subject to the background study required by section 144.057 and may be disqualified under chapter 245C. Nothing in this subdivision shall be construed to prohibit the facility from requiring self-disclosure of criminal conviction information. (b) Data collected under this subdivision shall be classified as private data on individuals under section 13.02, subdivision 12. (c) Termination of an employee in good faith reliance on information or records obtained under this section regarding a confirmed conviction does not subject the assisted living facility to civil liability or liability for unemployment benefits.
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Subd. 2. Qualifications, training, and competency. All staff persons providing assisted living services must be trained and competent in the provision of services consistent with current practice standards appropriate to the resident's needs, and promote and be trained to support the assisted living bill of rights. Subd. 3. Licensed health professionals and nurses. (a) Licensed health professionals and nurses providing services as employees of a licensed facility must possess a current Minnesota license or registration to practice. (b) Licensed health professionals and registered nurses must be competent in assessing resident needs, planning appropriate services to meet resident needs, implementing services, and supervising staff if assigned. (c) Nothing in this section limits or expands the rights of nurses or licensed health professionals to provide services within the scope of their licenses or registrations, as provided by law. Subd. 4. Unlicensed personnel. (a) Unlicensed personnel providing assisted living services must have: (1) successfully completed a training and competency evaluation appropriate to the services provided by the facility and the topics listed in section 144G.61, subdivision 2, paragraph (a); or (2) demonstrated competency by satisfactorily completing a written or oral test on the tasks the unlicensed personnel will perform and on the topics listed in section 144G.61, subdivision 2, paragraph (a); and successfully demonstrated competency on topics in section 144G.61, subdivision 2, paragraph (a), clauses (5), (7), and (8), by a practical skills test. Unlicensed personnel who only provide assisted living services listed in section 144G.08, subdivision 9, clauses (1) to (5), shall not perform delegated nursing or therapy tasks. (b) Unlicensed personnel performing delegated nursing tasks in an assisted living facility must: (1) have successfully completed training and demonstrated competency by successfully completing a written or oral test of the topics in section 144G.61, subdivision 2, paragraphs (a) and (b), and a practical skills test on tasks listed in section 144G.61, subdivision 2, paragraphs (a), clauses (5) and (7), and (b), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; (2) satisfy the current requirements of Medicare for training or competency of home health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, section 483 or 484.36; or (3) have, before April 19, 1993, completed a training course for nursing assistants that was approved by the commissioner. (c) Unlicensed personnel performing therapy or treatment tasks delegated or assigned by a licensed health professional must meet the requirements for delegated tasks in section 144G.62, subdivision 2, paragraph (a), and any other training or competency requirements within the licensed health professional's scope of practice relating to delegation or assignment of tasks to unlicensed personnel. Subd. 5. Temporary staff. When a facility contracts with a temporary staffing agency, those individuals must meet the same requirements required by this section for personnel employed by the facility and shall be treated as if they are staff of the facility. History: 2019 c 60 art 1 s 7,16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 7 and 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 7 and 16, the effective dates.
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144G.61 STAFF COMPETENCY EVALUATIONS. Subdivision 1. Instructor and competency evaluation requirements. Instructors and competency evaluators must meet the following requirements: (1) training and competency evaluations of unlicensed personnel who only provide assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), must be conducted by individuals with work experience and training in providing these services; and (2) training and competency evaluations of unlicensed personnel providing assisted living services must be conducted by a registered nurse, or another instructor may provide training in conjunction with the registered nurse. Subd. 2. Training and evaluation of unlicensed personnel. (a) Training and competency evaluations for all unlicensed personnel must include the following: (1) documentation requirements for all services provided; (2) reports of changes in the resident's condition to the supervisor designated by the facility; (3) basic infection control, including blood-borne pathogens; (4) maintenance of a clean and safe environment; (5) appropriate and safe techniques in personal hygiene and grooming, including: (i) hair care and bathing; (ii) care of teeth, gums, and oral prosthetic devices; (iii) care and use of hearing aids; and (iv) dressing and assisting with toileting; (6) training on the prevention of falls; (7) standby assistance techniques and how to perform them; (8) medication, exercise, and treatment reminders; (9) basic nutrition, meal preparation, food safety, and assistance with eating; (10) preparation of modified diets as ordered by a licensed health professional; (11) communication skills that include preserving the dignity of the resident and showing respect for the resident and the resident's preferences, cultural background, and family; (12) awareness of confidentiality and privacy; (13) understanding appropriate boundaries between staff and residents and the resident's family; (14) procedures to use in handling various emergency situations; and (15) awareness of commonly used health technology equipment and assistive devices. (b) In addition to paragraph (a), training and competency evaluation for unlicensed personnel providing assisted living services must include:
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(1) observing, reporting, and documenting resident status; (2) basic knowledge of body functioning and changes in body functioning, injuries, or other observed changes that must be reported to appropriate personnel; (3) reading and recording temperature, pulse, and respirations of the resident; (4) recognizing physical, emotional, cognitive, and developmental needs of the resident; (5) safe transfer techniques and ambulation; (6) range of motioning and positioning; and (7) administering medications or treatments as required. History: 2019 c 60 art 1 s 16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 16, the effective date. 144G.62 DELEGATION AND SUPERVISION. Subdivision 1. Availability of contact person to staff. (a) Assisted living facilities must have a registered nurse available for consultation by staff performing delegated nursing tasks and must have an appropriate licensed health professional available if performing other delegated services such as therapies. (b) The appropriate contact person must be readily available either in person, by telephone, or by other means to the staff at times when the staff is providing services. Subd. 2. Delegation of assisted living services. (a) A registered nurse or licensed health professional may delegate tasks only to staff who are competent and possess the knowledge and skills consistent with the complexity of the tasks and according to the appropriate Minnesota practice act. The assisted living facility must establish and implement a system to communicate up-to-date information to the registered nurse or licensed health professional regarding the current available staff and their competency so the registered nurse or licensed health professional has sufficient information to determine the appropriateness of delegating tasks to meet individual resident needs and preferences. (b) When the registered nurse or licensed health professional delegates tasks to unlicensed personnel, that person must ensure that prior to the delegation the unlicensed personnel is trained in the proper methods to perform the tasks or procedures for each resident and is able to demonstrate the ability to competently follow the procedures and perform the tasks. If an unlicensed personnel has not regularly performed the delegated assisted living task for a period of 24 consecutive months, the unlicensed personnel must demonstrate competency in the task to the registered nurse or appropriate licensed health professional. The registered nurse or licensed health professional must document instructions for the delegated tasks in the resident's record. Subd. 3. Supervision of staff. (a) Staff who only provide assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), must be supervised periodically where the services are being provided to verify that the work is being performed competently and to identify problems and solutions to address issues relating to the staff's ability to provide the services. The supervision of the unlicensed personnel must be done by staff of the facility having the authority, skills, and ability to provide the supervision of unlicensed personnel and who can implement changes as needed, and train staff.
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(b) Supervision includes direct observation of unlicensed personnel while the unlicensed personnel are providing the services and may also include indirect methods of gaining input such as gathering feedback from the resident. Supervisory review of staff must be provided at a frequency based on the staff person's competency and performance. Subd. 4. Supervision of staff providing delegated nursing or therapy tasks. (a) Staff who perform delegated nursing or therapy tasks must be supervised by an appropriate licensed health professional or a registered nurse according to the assisted living facility's policy where the services are being provided to verify that the work is being performed competently and to identify problems and solutions related to the staff person's ability to perform the tasks. Supervision of staff performing medication or treatment administration shall be provided by a registered nurse or appropriate licensed health professional and must include observation of the staff administering the medication or treatment and the interaction with the resident. (b) The direct supervision of staff performing delegated tasks must be provided within 30 calendar days after the date on which the individual begins working for the facility and first performs the delegated tasks for residents and thereafter as needed based on performance. This requirement also applies to staff who have not performed delegated tasks for one year or longer. Subd. 5. Documentation. A facility must retain documentation of supervision activities in the personnel records. History: 2019 c 60 art 1 s 16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 16, the effective date. 144G.63 ORIENTATION AND ANNUAL TRAINING REQUIREMENTS. Subdivision 1. Orientation of staff and supervisors. All staff providing and supervising direct services must complete an orientation to assisted living facility licensing requirements and regulations before providing assisted living services to residents. The orientation may be incorporated into the training required under subdivision 5. The orientation need only be completed once for each staff person and is not transferable to another facility. Subd. 2. Content of required orientation. (a) The orientation must contain the following topics: (1) an overview of this chapter; (2) an introduction and review of the facility's policies and procedures related to the provision of assisted living services by the individual staff person; (3) handling of emergencies and use of emergency services; (4) compliance with and reporting of the maltreatment of vulnerable adults under section 626.557 to the Minnesota Adult Abuse Reporting Center (MAARC); (5) the assisted living bill of rights and staff responsibilities related to ensuring the exercise and protection of those rights; (6) the principles of person-centered planning and service delivery and how they apply to direct support services provided by the staff person;
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(7) handling of residents' complaints, reporting of complaints, and where to report complaints, including information on the Office of Health Facility Complaints; (8) consumer advocacy services of the Office of Ombudsman for Long-Term Care, Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care Ombudsman at the Department of Human Services, county-managed care advocates, or other relevant advocacy services; and (9) a review of the types of assisted living services the employee will be providing and the facility's category of licensure. (b) In addition to the topics in paragraph (a), orientation may also contain training on providing services to residents with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and the challenges it poses to communication; (2) health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 3. Orientation to resident. Staff providing assisted living services must be oriented specifically to each individual resident and the services to be provided. This orientation may be provided in person, orally, in writing, or electronically. Subd. 4. Training required relating to dementia. All direct care staff and supervisors providing direct services must demonstrate an understanding of the training specified in section 144G.64. Subd. 5. Required annual training. (a) All staff that perform direct services must complete at least eight hours of annual training for each 12 months of employment. The training may be obtained from the facility or another source and must include topics relevant to the provision of assisted living services. The annual training must include: (1) training on reporting of maltreatment of vulnerable adults under section 626.557; (2) review of the assisted living bill of rights and staff responsibilities related to ensuring the exercise and protection of those rights; (3) review of infection control techniques used in the home and implementation of infection control standards including a review of hand washing techniques; the need for and use of protective gloves, gowns, and masks; appropriate disposal of contaminated materials and equipment, such as dressings, needles, syringes, and razor blades; disinfecting reusable equipment; disinfecting environmental surfaces; and reporting communicable diseases; (4) effective approaches to use to problem solve when working with a resident's challenging behaviors, and how to communicate with residents who have dementia, Alzheimer's disease, or related disorders; (5) review of the facility's policies and procedures relating to the provision of assisted living services and how to implement those policies and procedures; and
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(6) the principles of person-centered planning and service delivery and how they apply to direct support services provided by the staff person. (b) In addition to the topics in paragraph (a), annual training may also contain training on providing services to residents with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and challenges it poses to communication; (2) the health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 6. Implementation. The assisted living facility must implement all orientation and training topics covered in this section. Subd. 7. Verification and documentation of orientation and training. The assisted living facility shall retain evidence in the employee record of each staff person having completed the orientation and training required by this section. History: 2019 c 60 art 1 s 22,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 22, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 22, the effective date. 144G.64 TRAINING IN DEMENTIA CARE REQUIRED. (a) All assisted living facilities must meet the following training requirements: (1) supervisors of direct-care staff must have at least eight hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (3) for assisted living facilities with dementia care, direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 80 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with
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the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (4) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (5) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. (b) Areas of required training include: (1) an explanation of Alzheimer's disease and other dementias; (2) assistance with activities of daily living; (3) problem solving with challenging behaviors; (4) communication skills; and (5) person-centered planning and service delivery. (c) The facility shall provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered. History: 2019 c 60 art 1 s 23,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 23, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 23, the effective date. SERVICES 144G.70 SERVICES. Subdivision 1. Acceptance of residents. An assisted living facility may not accept a person as a resident unless the facility has staff, sufficient in qualifications, competency, and numbers, to adequately provide the services agreed to in the assisted living contract. Subd. 2. Initial reviews, assessments, and monitoring. (a) Residents who are not receiving any services shall not be required to undergo an initial nursing assessment. (b) An assisted living facility shall conduct a nursing assessment by a registered nurse of the physical and cognitive needs of the prospective resident and propose a temporary service plan prior to the date on which a prospective resident executes a contract with a facility or the date on which a prospective resident moves in, whichever is earlier. If necessitated by either the geographic distance between the prospective resident and the facility, or urgent or unexpected circumstances, the assessment may be conducted using telecommunication methods based on practice standards that meet the resident's needs and reflect person-centered planning and care delivery. (c) Resident reassessment and monitoring must be conducted no more than 14 calendar days after initiation of services. Ongoing resident reassessment and monitoring must be conducted as needed based
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on changes in the needs of the resident and cannot exceed 90 calendar days from the last date of the assessment. (d) For residents only receiving assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), the facility shall complete an individualized initial review of the resident's needs and preferences. The initial review must be completed within 30 calendar days of the start of services. Resident monitoring and review must be conducted as needed based on changes in the needs of the resident and cannot exceed 90 calendar days from the date of the last review. (e) A facility must inform the prospective resident of the availability of and contact information for long-term care consultation services under section 256B.0911, prior to the date on which a prospective resident executes a contract with a facility or the date on which a prospective resident moves in, whichever is earlier. Subd. 3. Temporary service plan. When a facility initiates services and the individualized assessment required in subdivision 2 has not been completed, the facility must complete a temporary plan and agreement with the resident for services. A temporary service plan shall not be effective for more than 72 hours. Subd. 4. Service plan, implementation, and revisions to service plan. (a) No later than 14 calendar days after the date that services are first provided, an assisted living facility shall finalize a current written service plan. (b) The service plan and any revisions must include a signature or other authentication by the facility and by the resident documenting agreement on the services to be provided. The service plan must be revised, if needed, based on resident reassessment under subdivision 2. The facility must provide information to the resident about changes to the facility's fee for services and how to contact the Office of Ombudsman for Long-Term Care. (c) The facility must implement and provide all services required by the current service plan. (d) The service plan and the revised service plan must be entered into the resident record, including notice of a change in a resident's fees when applicable. (e) Staff providing services must be informed of the current written service plan. (f) The service plan must include: (1) a description of the services to be provided, the fees for services, and the frequency of each service, according to the resident's current assessment and resident preferences; (2) the identification of staff or categories of staff who will provide the services; (3) the schedule and methods of monitoring assessments of the resident; (4) the schedule and methods of monitoring staff providing services; and (5) a contingency plan that includes: (i) the action to be taken if the scheduled service cannot be provided; (ii) information and a method to contact the facility;
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(iii) the names and contact information of persons the resident wishes to have notified in an emergency or if there is a significant adverse change in the resident's condition, including identification of and information as to who has authority to sign for the resident in an emergency; and (iv) the circumstances in which emergency medical services are not to be summoned consistent with chapters 145B and 145C, and declarations made by the resident under those chapters. Subd. 5. Referrals. If a facility reasonably believes that a resident is in need of another medical or health service, including a licensed health professional, or social service provider, the facility shall: (1) determine the resident's preferences with respect to obtaining the service; and (2) inform the resident of the resources available, if known, to assist the resident in obtaining services. Subd. 6. Medical cannabis. Assisted living facilities may exercise the authority and are subject to the protections in section 152.34. Subd. 7. Request for discontinuation of life-sustaining treatment. (a) If a resident, family member, or other caregiver of the resident requests that an employee or other agent of the facility discontinue a life-sustaining treatment, the employee or agent receiving the request: (1) shall take no action to discontinue the treatment; and (2) shall promptly inform the supervisor or other agent of the facility of the resident's request. (b) Upon being informed of a request for discontinuance of treatment, the facility shall promptly: (1) inform the resident that the request will be made known to the physician or advanced practice registered nurse who ordered the resident's treatment; (2) inform the physician or advanced practice registered nurse of the resident's request; and (3) work with the resident and the resident's physician or advanced practice registered nurse to comply with chapter 145C. (c) This section does not require the facility to discontinue treatment, except as may be required by law or court order. (d) This section does not diminish the rights of residents to control their treatments, refuse services, or terminate their relationships with the facility. (e) This section shall be construed in a manner consistent with chapter 145B or 145C, whichever applies, and declarations made by residents under those chapters. History: 2019 c 60 art 1 s 18,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 18, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 18, the effective date. 144G.71 MEDICATION MANAGEMENT. Subdivision 1. Medication management services. (a) This section applies only to assisted living facilities that provide medication management services.
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(b) An assisted living facility that provides medication management services must develop, implement, and maintain current written medication management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current practice standards and guidelines. (c) The written policies and procedures must address requesting and receiving prescriptions for medications; preparing and giving medications; verifying that prescription drugs are administered as prescribed; documenting medication management activities; controlling and storing medications; monitoring and evaluating medication use; resolving medication errors; communicating with the prescriber, pharmacist, and resident and legal and designated representatives; disposing of unused medications; and educating residents and legal and designated representatives about medications. When controlled substances are being managed, the policies and procedures must also identify how the provider will ensure security and accountability for the overall management, control, and disposition of those substances in compliance with state and federal regulations and with subdivision 23. Subd. 2. Provision of medication management services. (a) For each resident who requests medication management services, the facility shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber under section 151.37 conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must be conducted face-to-face with the resident. The assessment must include an identification and review of all medications the resident is known to be taking. The review and identification must include indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues. (b) The assessment must identify interventions needed in management of medications to prevent diversion of medication by the resident or others who may have access to the medications and provide instructions to the resident and legal or designated representatives on interventions to manage the resident's medications and prevent diversion of medications. For purposes of this section, "diversion of medication" means misuse, theft, or illegal or improper disposition of medications. Subd. 3. Individualized medication monitoring and reassessment. The assisted living facility must monitor and reassess the resident's medication management services as needed under subdivision 2 when the resident presents with symptoms or other issues that may be medication-related and, at a minimum, annually. Subd. 4. Resident refusal. The assisted living facility must document in the resident's record any refusal for an assessment for medication management by the resident. The facility must discuss with the resident the possible consequences of the resident's refusal and document the discussion in the resident's record. Subd. 5. Individualized medication management plan. (a) For each resident receiving medication management services, the assisted living facility must prepare and include in the service plan a written statement of the medication management services that will be provided to the resident. The facility must develop and maintain a current individualized medication management record for each resident based on the resident's assessment that must contain the following: (1) a statement describing the medication management services that will be provided; (2) a description of storage of medications based on the resident's needs and preferences, risk of diversion, and consistent with the manufacturer's directions; (3) documentation of specific resident instructions relating to the administration of medications;
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(4) identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis; (5) identification of medication management tasks that may be delegated to unlicensed personnel; (6) procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; and (7) any resident-specific requirements relating to documenting medication administration, verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions. (b) The medication management record must be current and updated when there are any changes. (c) Medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management. Subd. 6. Administration of medication. Medications may be administered by a nurse, physician, or other licensed health practitioner authorized to administer medications or by unlicensed personnel who have been delegated medication administration tasks by a registered nurse. Subd. 7. Delegation of medication administration. When administration of medications is delegated to unlicensed personnel, the assisted living facility must ensure that the registered nurse has: (1) instructed the unlicensed personnel in the proper methods to administer the medications, and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each resident and documented those instructions in the resident's records; and (3) communicated with the unlicensed personnel about the individual needs of the resident. Subd. 8. Documentation of administration of medications. Each medication administered by the assisted living facility staff must be documented in the resident's record. The documentation must include the signature and title of the person who administered the medication. The documentation must include the medication name, dosage, date and time administered, and method and route of administration. The staff must document the reason why medication administration was not completed as prescribed and document any follow-up procedures that were provided to meet the resident's needs when medication was not administered as prescribed and in compliance with the resident's medication management plan. Subd. 9. Documentation of medication setup. Documentation of dates of medication setup, name of medication, quantity of dose, times to be administered, route of administration, and name of person completing medication setup must be done at the time of setup. Subd. 10. Medication management for residents who will be away from home. (a) An assisted living facility that is providing medication management services to the resident must develop and implement policies and procedures for giving accurate and current medications to residents for planned or unplanned times away from home according to the resident's individualized medication management plan. The policies and procedures must state that: (1) for planned time away, the medications must be obtained from the pharmacy or set up by the licensed nurse according to appropriate state and federal laws and nursing standards of practice;
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(2) for unplanned time away, when the pharmacy is not able to provide the medications, a licensed nurse or unlicensed personnel shall provide medications in amounts and dosages needed for the length of the anticipated absence, not to exceed seven calendar days; (3) the resident must be provided written information on medications, including any special instructions for administering or handling the medications, including controlled substances; and (4) the medications must be placed in a medication container or containers appropriate to the provider's medication system and must be labeled with the resident's name and the dates and times that the medications are scheduled. (b) For unplanned time away when the licensed nurse is not available, the registered nurse may delegate this task to unlicensed personnel if: (1) the registered nurse has trained the unlicensed staff and determined the unlicensed staff is competent to follow the procedures for giving medications to residents; and (2) the registered nurse has developed written procedures for the unlicensed personnel, including any special instructions or procedures regarding controlled substances that are prescribed for the resident. The procedures must address: (i) the type of container or containers to be used for the medications appropriate to the provider's medication system; (ii) how the container or containers must be labeled; (iii) written information about the medications to be provided; (iv) how the unlicensed staff must document in the resident's record that medications have been provided, including documenting the date the medications were provided and who received the medications, the person who provided the medications to the resident, the number of medications that were provided to the resident, and other required information; (v) how the registered nurse shall be notified that medications have been provided and whether the registered nurse needs to be contacted before the medications are given to the resident or the designated representative; (vi) a review by the registered nurse of the completion of this task to verify that this task was completed accurately by the unlicensed personnel; and (vii) how the unlicensed personnel must document in the resident's record any unused medications that are returned to the facility, including the name of each medication and the doses of each returned medication. Subd. 11. Prescribed and nonprescribed medication. The assisted living facility must determine whether the facility shall require a prescription for all medications the provider manages. The facility must inform the resident whether the facility requires a prescription for all over-the-counter and dietary supplements before the facility agrees to manage those medications. Subd. 12. Medications; over-the-counter drugs; dietary supplements not prescribed. An assisted living facility providing medication management services for over-the-counter drugs or dietary supplements must retain those items in the original labeled container with directions for use prior to setting up for immediate or later administration. The facility must verify that the medications are up to date and stored as appropriate.
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Subd. 13. Prescriptions. There must be a current written or electronically recorded prescription as defined in section 151.01, subdivision 16a, for all prescribed medications that the assisted living facility is managing for the resident. Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least every 12 months or more frequently as indicated by the assessment in subdivision 2. Prescriptions for controlled substances must comply with chapter 152. Subd. 15. Verbal prescription orders. Verbal prescription orders from an authorized prescriber must be received by a nurse or pharmacist. The order must be handled according to Minnesota Rules, part 6800.6200. Subd. 16. Written or electronic prescription. When a written or electronic prescription is received, it must be communicated to the registered nurse in charge and recorded or placed in the resident's record. Subd. 17. Records confidential. A prescription or order received verbally, in writing, or electronically must be kept confidential according to sections 144.291 to 144.298 and 144A.44. Subd. 18. Medications provided by resident or family members. When the assisted living facility is aware of any medications or dietary supplements that are being used by the resident and are not included in the assessment for medication management services, the staff must advise the registered nurse and document that in the resident record. Subd. 19. Storage of medications. An assisted living facility must store all prescription medications in securely locked and substantially constructed compartments according to the manufacturer's directions and permit only authorized personnel to have access. Subd. 20. Prescription drugs. A prescription drug, prior to being set up for immediate or later administration, must be kept in the original container in which it was dispensed by the pharmacy bearing the original prescription label with legible information including the expiration or beyond-use date of a time-dated drug. Subd. 21. Prohibitions. No prescription drug supply for one resident may be used or saved for use by anyone other than the resident. Subd. 22. Disposition of medications. (a) Any current medications being managed by the assisted living facility must be provided to the resident when the resident's service plan ends or medication management services are no longer part of the service plan. Medications for a resident who is deceased or that have been discontinued or have expired may be provided for disposal. (b) The facility shall dispose of any medications remaining with the facility that are discontinued or expired or upon the termination of the service contract or the resident's death according to state and federal regulations for disposition of medications and controlled substances. (c) Upon disposition, the facility must document in the resident's record the disposition of the medication including the medication's name, strength, prescription number as applicable, quantity, to whom the medications were given, date of disposition, and names of staff and other individuals involved in the disposition. Subd. 23. Loss or spillage. (a) Assisted living facilities providing medication management must develop and implement procedures for loss or spillage of all controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must require that when a spillage of a controlled substance occurs, a notation
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must be made in the resident's record explaining the spillage and the actions taken. The notation must be signed by the person responsible for the spillage and include verification that any contaminated substance was disposed of according to state or federal regulations. (b) The procedures must require that the facility providing medication management investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state or federal regulations and document the investigation in required records. History: 2019 c 60 art 1 s 19,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 19, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 19, the effective date. 144G.72 TREATMENT AND THERAPY MANAGEMENT SERVICES. Subdivision 1. Treatment and therapy management services. This section applies only to assisted living facilities that provide treatment and therapy management services. Subd. 2. Policies and procedures. (a) An assisted living facility that provides treatment and therapy management services must develop, implement, and maintain up-to-date written treatment or therapy management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse or appropriate licensed health professional consistent with current practice standards and guidelines. (b) The written policies and procedures must address requesting and receiving orders or prescriptions for treatments or therapies, providing the treatment or therapy, documenting treatment or therapy activities, educating and communicating with residents about treatments or therapies they are receiving, monitoring and evaluating the treatment or therapy, and communicating with the prescriber. Subd. 3. Individualized treatment or therapy management plan. For each resident receiving management of ordered or prescribed treatments or therapy services, the assisted living facility must prepare and include in the service plan a written statement of the treatment or therapy services that will be provided to the resident. The facility must also develop and maintain a current individualized treatment and therapy management record for each resident which must contain at least the following: (1) a statement of the type of services that will be provided; (2) documentation of specific resident instructions relating to the treatments or therapy administration; (3) identification of treatment or therapy tasks that will be delegated to unlicensed personnel; (4) procedures for notifying a registered nurse or appropriate licensed health professional when a problem arises with treatments or therapy services; and (5) any resident-specific requirements relating to documentation of treatment and therapy received, verification that all treatment and therapy was administered as prescribed, and monitoring of treatment or therapy to prevent possible complications or adverse reactions. The treatment or therapy management record must be current and updated when there are any changes. Subd. 4. Administration of treatments and therapy. Ordered or prescribed treatments or therapies must be administered by a nurse, physician, or other licensed health professional authorized to perform the treatment or therapy, or may be delegated or assigned to unlicensed personnel by the licensed health professional according to the appropriate practice standards for delegation or assignment. When administration
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of a treatment or therapy is delegated or assigned to unlicensed personnel, the facility must ensure that the registered nurse or authorized licensed health professional has: (1) instructed the unlicensed personnel in the proper methods with respect to each resident and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each resident and documented those instructions in the resident's record; and (3) communicated with the unlicensed personnel about the individual needs of the resident. Subd. 5. Documentation of administration of treatments and therapies. Each treatment or therapy administered by an assisted living facility must be in the resident record. The documentation must include the signature and title of the person who administered the treatment or therapy and must include the date and time of administration. When treatment or therapies are not administered as ordered or prescribed, the provider must document the reason why it was not administered and any follow-up procedures that were provided to meet the resident's needs. Subd. 6. Treatment and therapy orders. There must be an up-to-date written or electronically recorded order from an authorized prescriber for all treatments and therapies. The order must contain the name of the resident, a description of the treatment or therapy to be provided, and the frequency, duration, and other information needed to administer the treatment or therapy. Treatment and therapy orders must be renewed at least every 12 months. Subd. 7. Right to outside service provider; other payors. Under section 144G.91, a resident is free to retain therapy and treatment services from an off-site service provider. Assisted living facilities must make every effort to assist residents in obtaining information regarding whether the Medicare program, the medical assistance program under chapter 256B, or another public program will pay for any or all of the services. History: 2019 c 60 art 1 s 20,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 20, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 20, the effective date. ASSISTED LIVING FACILITIES WITH DEMENTIA CARE 144G.80 ADDITIONAL LICENSING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. Applicability. This section applies only to assisted living facilities with dementia care. Subd. 2. Demonstrated capacity. (a) An applicant for licensure as an assisted living facility with dementia care must have the ability to provide services in a manner that is consistent with the requirements in this section. The commissioner shall consider the following criteria, including, but not limited to: (1) the experience of the applicant in managing residents with dementia or previous long-term care experience; and (2) the compliance history of the applicant in the operation of any care facility licensed, certified, or registered under federal or state law.
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(b) If the applicant does not have experience in managing residents with dementia, the applicant must employ a consultant for at least the first six months of operation. The consultant must meet the requirements in paragraph (a), clause (1), and make recommendations on providing dementia care services consistent with the requirements of this chapter. The consultant must (1) have two years of work experience related to dementia, health care, gerontology, or a related field, and (2) have completed at least the minimum core training requirements in section 144G.64. The applicant must document an acceptable plan to address the consultant's identified concerns and must either implement the recommendations or document in the plan any consultant recommendations that the applicant chooses not to implement. The commissioner must review the applicant's plan upon request. (c) The commissioner shall conduct an on-site inspection prior to the issuance of an assisted living facility with dementia care license to ensure compliance with the physical environment requirements. (d) The label "Assisted Living Facility with Dementia Care" must be identified on the license. Subd. 3. Relinquishing license. (a) The licensee must notify the commissioner and the Office of Ombudsman for Long-Term Care in writing at least 60 calendar days prior to the voluntary relinquishment of an assisted living facility with dementia care license. For voluntary relinquishment, the facility must at least: (1) give all residents and their designated and legal representatives 60 calendar days' notice. The notice must include at a minimum: (i) the proposed effective date of the relinquishment; (ii) changes in staffing; (iii) changes in services including the elimination or addition of services; (iv) staff training that shall occur when the relinquishment becomes effective; and (v) contact information for the Office of Ombudsman for Long-Term Care; (2) submit a transitional plan to the commissioner demonstrating how the current residents shall be evaluated and assessed to reside in other housing settings that are not an assisted living facility with dementia care, that are physically unsecured, or that would require move-out or transfer to other settings; (3) change service or care plans as appropriate to address any needs the residents may have with the transition; (4) notify the commissioner when the relinquishment process has been completed; and (5) revise advertising materials and disclosure information to remove any reference that the facility is an assisted living facility with dementia care. (b) Nothing in this section alters obligations under section 144G.57. History: 2019 c 60 art 1 s 47; art 2 s 1 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 1, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 1, the effective date.
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144G.81 ADDITIONAL REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH SECURED DEMENTIA CARE UNITS. Subdivision 1. Fire protection and physical environment. An assisted living facility with dementia care that has a secured dementia care unit must meet the requirements of section 144G.45 and the following additional requirements: (1) a hazard vulnerability assessment or safety risk must be performed on and around the property. The hazards indicated on the assessment must be assessed and mitigated to protect the residents from harm; and (2) the facility shall be protected throughout by an approved supervised automatic sprinkler system by August 1, 2029. Subd. 2. Fire drills. Fire drills in secured dementia care units in assisted living facilities with dementia care shall be conducted in accordance with the NFPA Standard 101, Life Safety Code, Healthcare (limited care) chapter. Subd. 3. Assisted living facilities with dementia care and secured dementia care unit; Life Safety Code. (a) All assisted living facilities with dementia care and a secured dementia care unit must meet the applicable provisions of the most current edition of the NFPA Standard 101, Life Safety Code, Healthcare (limited care) chapter. The minimum design standards shall be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. (b) If the commissioner decides to update the Life Safety Code for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new Life Safety Code will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities with dementia care and a secured dementia care unit beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which these facilities must comply with the updated Life Safety Code. The date by which these facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 4. Awake staff requirement. An assisted living facility with dementia care providing services in a secured dementia care unit must have an awake person who is physically present in the secured dementia care unit 24 hours per day, seven days per week, who is responsible for responding to the requests of residents for assistance with health and safety needs, and who meets the requirements of section 144G.41, subdivision 1, clause (12). Subd. 5. Variance or waiver. A facility may request under section 144G.45, subdivision 7, that the commissioner grant a variance or waiver from the provisions of this section, except subdivision 4. History: 2019 c 60 art 1 s 11,25,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 11 and 25, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 11 and 25, the effective dates. 144G.82 ADDITIONAL RESPONSIBILITIES OF ADMINISTRATION FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. General. The licensee of an assisted living facility with dementia care is responsible for the care and housing of the persons with dementia and the provision of person-centered care that promotes
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each resident's dignity, independence, and comfort. This includes the supervision, training, and overall conduct of the staff. Subd. 2. Additional requirements. (a) The licensee must follow the assisted living license requirements and the criteria in this section. (b) The assisted living director of an assisted living facility with dementia care must complete and document that at least ten hours of the required annual continuing educational requirements relate to the care of individuals with dementia. The training must include medical management of dementia, creating and maintaining supportive and therapeutic environments for residents with dementia, and transitioning and coordinating services for residents with dementia. Continuing education credits may include college courses, preceptor credits, self-directed activities, course instructor credits, corporate training, in-service training, professional association training, web-based training, correspondence courses, telecourses, seminars, and workshops. Subd. 3. Policies. (a) In addition to the policies and procedures required in the licensing of all facilities, the assisted living facility with dementia care licensee must develop and implement policies and procedures that address the: (1) philosophy of how services are provided based upon the assisted living facility licensee's values, mission, and promotion of person-centered care and how the philosophy shall be implemented; (2) evaluation of behavioral symptoms and design of supports for intervention plans, including nonpharmacological practices that are person-centered and evidence-informed; (3) wandering and egress prevention that provides detailed instructions to staff in the event a resident elopes; (4) medication management, including an assessment of residents for the use and effects of medications, including psychotropic medications; (5) staff training specific to dementia care; (6) description of life enrichment programs and how activities are implemented; (7) description of family support programs and efforts to keep the family engaged; (8) limiting the use of public address and intercom systems for emergencies and evacuation drills only; (9) transportation coordination and assistance to and from outside medical appointments; and (10) safekeeping of residents' possessions. (b) The policies and procedures must be provided to residents and the residents' legal and designated representatives at the time of move-in. History: 2019 c 60 art 1 s 47; art 2 s 2 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 2, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 2, the effective date.
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144G.83 ADDITIONAL TRAINING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. General. (a) An assisted living facility with dementia care must provide residents with dementia-trained staff who have been instructed in the person-centered care approach. All direct care staff assigned to care for residents with dementia must be specially trained to work with residents with Alzheimer's disease and other dementias. (b) Only staff trained as specified in subdivisions 2 and 3 shall be assigned to care for dementia residents. (c) Staffing levels must be sufficient to meet the scheduled and unscheduled needs of residents. Staffing levels during nighttime hours shall be based on the sleep patterns and needs of residents. (d) In an emergency situation when trained staff are not available to provide services, the facility may assign staff who have not completed the required training. The particular emergency situation must be documented and must address: (1) the nature of the emergency; (2) how long the emergency lasted; and (3) the names and positions of staff that provided coverage. Subd. 2. Staffing requirements. (a) The licensee must ensure that staff who provide support to residents with dementia can demonstrate a basic understanding and ability to apply dementia training to the residents' emotional and unique health care needs using person-centered planning delivery. Direct care dementia-trained staff and other staff must be trained on the topics identified during the expedited rulemaking process. These requirements are in addition to the licensing requirements for training. (b) Failure to comply with paragraph (a) or subdivision 1 shall result in a fine under section 144G.31. Subd. 3. Supervising staff training. Persons providing or overseeing staff training must have experience and knowledge in the care of individuals with dementia, including: (1) two years of work experience related to Alzheimer's disease or other dementias, or in health care, gerontology, or another related field; and (2) completion of training equivalent to the requirements in this section and successfully passing a skills competency or knowledge test required by the commissioner. Subd. 4. Preservice and in-service training. Preservice and in-service training may include various methods of instruction, such as classroom style, web-based training, video, or one-to-one training. The licensee must have a method for determining and documenting each staff person's knowledge and understanding of the training provided. All training must be documented. History: 2019 c 60 art 1 s 47; art 2 s 3 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 3, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 3, the effective date. 144G.84 SERVICES FOR RESIDENTS WITH DEMENTIA. (a) In addition to the minimum services required in section 144G.41, an assisted living facility with dementia care must also provide the following services:
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(1) assistance with activities of daily living that address the needs of each resident with dementia due to cognitive or physical limitations. These services must meet or be in addition to the requirements in the licensing rules for the facility. Services must be provided in a person-centered manner that promotes resident choice, dignity, and sustains the resident's abilities; (2) nonpharmacological practices that are person-centered and evidence-informed; (3) services to prepare and educate persons living with dementia and their legal and designated representatives about transitions in care and ensuring complete, timely communication between, across, and within settings; and (4) services that provide residents with choices for meaningful engagement with other facility residents and the broader community. (b) Each resident must be evaluated for activities according to the licensing rules of the facility. In addition, the evaluation must address the following: (1) past and current interests; (2) current abilities and skills; (3) emotional and social needs and patterns; (4) physical abilities and limitations; (5) adaptations necessary for the resident to participate; and (6) identification of activities for behavioral interventions. (c) An individualized activity plan must be developed for each resident based on their activity evaluation. The plan must reflect the resident's activity preferences and needs. (d) A selection of daily structured and non-structured activities must be provided and included on the resident's activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (1) occupation or chore related tasks; (2) scheduled and planned events such as entertainment or outings; (3) spontaneous activities for enjoyment or those that may help defuse a behavior; (4) one-to-one activities that encourage positive relationships between residents and staff such as telling a life story, reminiscing, or playing music; (5) spiritual, creative, and intellectual activities; (6) sensory stimulation activities; (7) physical activities that enhance or maintain a resident's ability to ambulate or move; and (8) outdoor activities. (e) Behavioral symptoms that negatively impact the resident and others in the assisted living facility with dementia care must be evaluated and included on the service or care plan. The staff must initiate and coordinate outside consultation or acute care when indicated.
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(f) Support must be offered to family and other significant relationships on a regularly scheduled basis but not less than quarterly. (g) Access to secured outdoor space and walkways that allow residents to enter and return without staff assistance must be provided. History: 2019 c 60 art 1 s 47; art 2 s 4 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 4, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 4, the effective date. RESIDENT RIGHTS AND PROTECTIONS 144G.90 REQUIRED NOTICES. Subdivision 1. Assisted living bill of rights; notification to resident. (a) An assisted living facility must provide the resident a written notice of the rights under section 144G.91 before the initiation of services to that resident. The facility shall make all reasonable efforts to provide notice of the rights to the resident in a language the resident can understand. (b) In addition to the text of the assisted living bill of rights in section 144G.91, the notice shall also contain the following statement describing how to file a complaint or report suspected abuse: "If you want to report suspected abuse, neglect, or financial exploitation, you may contact the Minnesota Adult Abuse Reporting Center (MAARC). If you have a complaint about the facility or person providing your services, you may contact the Office of Health Facility Complaints, Minnesota Department of Health. You may also contact the Office of Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health and Developmental Disabilities." (c) The statement must include contact information for the Minnesota Adult Abuse Reporting Center and the telephone number, website address, e-mail address, mailing address, and street address of the Office of Health Facility Complaints at the Minnesota Department of Health, the Office of Ombudsman for Long-Term Care, and the Office of Ombudsman for Mental Health and Developmental Disabilities. The statement must include the facility's name, address, e-mail, telephone number, and name or title of the person at the facility to whom problems or complaints may be directed. It must also include a statement that the facility will not retaliate because of a complaint. (d) A facility must obtain written acknowledgment from the resident of the resident's receipt of the assisted living bill of rights or shall document why an acknowledgment cannot be obtained. Acknowledgment of receipt shall be retained in the resident's record. Subd. 2. Notices in plain language; language accommodations. A facility must provide all notices in plain language that residents can understand and make reasonable accommodations for residents who have communication disabilities and those whose primary language is a language other than English. Subd. 3. Notice of dementia training. An assisted living facility with dementia care shall make available in written or electronic form, to residents and families or other persons who request it, a description of the training program and related training it provides, including the categories of employees trained, the frequency of training, and the basic topics covered. A hard copy of this notice must be provided upon request.
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Subd. 4. Notice of available assistance. A facility shall provide each resident with identifying and contact information about the persons who can assist with health care or supportive services being provided. A facility shall keep each resident informed of changes in the personnel referenced in this subdivision. Subd. 5. Notice to residents; change in ownership or management. (a) A facility must provide written notice to the resident, legal representative, or designated representative of a change of ownership within seven calendar days after the facility receives a new license. (b) A facility must provide prompt written notice to the resident, legal representative, or designated representative, of any change of legal name, telephone number, and physical mailing address, which may not be a public or private post office box, of: (1) the manager of the facility, if applicable; and (2) the authorized agent. History: 2019 c 60 art 1 s 17,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 17, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 17, the effective date. 144G.91 ASSISTED LIVING BILL OF RIGHTS. Subdivision 1. Applicability. This section applies to residents living in assisted living facilities. Subd. 2. Legislative intent. The rights established under this section for the benefit of residents do not limit any other rights available under law. No facility may request or require that any resident waive any of these rights at any time for any reason, including as a condition of admission to the facility. Subd. 3. Information about rights. Before receiving services, residents have the right to be informed by the facility of the rights granted under this section and the recourse residents have if rights are violated. The information must be in plain language and in terms residents can understand. The facility must make reasonable accommodations for residents who have communication disabilities and those who speak a language other than English. Subd. 4. Appropriate care and services. (a) Residents have the right to care and assisted living services that are appropriate based on the resident's needs and according to an up-to-date service plan subject to accepted health care standards. (b) Residents have the right to receive health care and other assisted living services with continuity from people who are properly trained and competent to perform their duties and in sufficient numbers to adequately provide the services agreed to in the assisted living contract and the service plan. Subd. 5. Refusal of care or services. Residents have the right to refuse care or assisted living services and to be informed by the facility of the medical, health-related, or psychological consequences of refusing care or services. Subd. 6. Participation in care and service planning. Residents have the right to actively participate in the planning, modification, and evaluation of their care and services. This right includes: (1) the opportunity to discuss care, services, treatment, and alternatives with the appropriate caregivers; (2) the right to include the resident's legal and designated representatives and persons of the resident's choosing; and
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(3) the right to be told in advance of, and take an active part in decisions regarding, any recommended changes in the service plan. Subd. 7. Courteous treatment. Residents have the right to be treated with courtesy and respect, and to have the resident's property treated with respect. Subd. 8. Freedom from maltreatment. Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act. Subd. 9. Right to come and go freely. Residents have the right to enter and leave the facility as they choose. This right may be restricted only as allowed by other law and consistent with a resident's service plan. Subd. 10. Individual autonomy. Residents have the right to individual autonomy, initiative, and independence in making life choices, including establishing a daily schedule and choosing with whom to interact. Subd. 11. Right to control resources. Residents have the right to control personal resources. Subd. 12. Visitors and social participation. (a) Residents have the right to meet with or receive visits at any time by the resident's family, guardian, conservator, health care agent, attorney, advocate, or religious or social work counselor, or any person of the resident's choosing. This right may be restricted in certain circumstances if necessary for the resident's health and safety and if documented in the resident's service plan. (b) Residents have the right to engage in community life and in activities of their choice. This includes the right to participate in commercial, religious, social, community, and political activities without interference and at their discretion if the activities do not infringe on the rights of other residents. Subd. 13. Personal and treatment privacy. (a) Residents have the right to consideration of their privacy, individuality, and cultural identity as related to their social, religious, and psychological well-being. Staff must respect the privacy of a resident's space by knocking on the door and seeking consent before entering, except in an emergency or where clearly inadvisable or unless otherwise documented in the resident's service plan. (b) Residents have the right to have and use a lockable door to the resident's unit. The facility shall provide locks on the resident's unit. Only a staff member with a specific need to enter the unit shall have keys. This right may be restricted in certain circumstances if necessary for a resident's health and safety and documented in the resident's service plan. (c) Residents have the right to respect and privacy regarding the resident's service plan. Case discussion, consultation, examination, and treatment are confidential and must be conducted discreetly. Privacy must be respected during toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance. Subd. 14. Communication privacy. (a) Residents have the right to communicate privately with persons of their choice. (b) If an assisted living facility is sending or receiving mail on behalf of residents, the assisted living facility must do so without interference. (c) Residents must be provided access to a telephone to make and receive calls.
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Subd. 15. Confidentiality of records. (a) Residents have the right to have personal, financial, health, and medical information kept private, to approve or refuse release of information to any outside party, and to be advised of the assisted living facility's policies and procedures regarding disclosure of the information. Residents must be notified when personal records are requested by any outside party. (b) Residents have the right to access their own records. Subd. 16. Right to furnish and decorate. Residents have the right to furnish and decorate the resident's unit within the terms of the assisted living contract. Subd. 17. Right to choose roommate. Residents have the right to choose a roommate if sharing a unit. Subd. 18. Right to access food. Residents have the right to access food at any time. This right may be restricted in certain circumstances if necessary for the resident's health and safety and if documented in the resident's service plan. Subd. 19. Access to technology. Residents have the right to access Internet service at their expense. Subd. 20. Grievances and inquiries. Residents have the right to make and receive a timely response to a complaint or inquiry, without limitation. Residents have the right to know and every facility must provide the name and contact information of the person representing the facility who is designated to handle and resolve complaints and inquiries. Subd. 21. Access to counsel and advocacy services. Residents have the right to the immediate access by: (1) the resident's legal counsel; (2) any representative of the protection and advocacy system designated by the state under Code of Federal Regulations, title 45, section 1326.21; or (3) any representative of the Office of Ombudsman for Long-Term Care. Subd. 22. Information about charges. Before services are initiated, residents have the right to be notified: (1) of all charges for housing and assisted living services; (2) of any limits on housing and assisted living services available; (3) if known, whether and what amount of payment may be expected from health insurance, public programs, or other sources; and (4) what charges the resident may be responsible for paying. Subd. 23. Information about individuals providing services. Before receiving services identified in the service plan, residents have the right to be told the type and disciplines of staff who will be providing the services, the frequency of visits proposed to be furnished, and other choices that are available for addressing the resident's needs. Subd. 24. Information about other providers and services. Residents have the right to be informed by the assisted living facility, prior to executing an assisted living contract, that other public and private services may be available and that the resident has the right to purchase, contract for, or obtain services from a provider other than the assisted living facility.
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Subd. 25. Resident councils. Residents have the right to organize and participate in resident councils as described in section 144G.41, subdivision 5. Subd. 26. Family councils. Residents have the right to participate in family councils formed by families or residents as described in section 144G.41, subdivision 6. History: 2019 c 60 art 1 s 12,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 12, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 12, the effective date. 144G.911 RESTRICTIONS UNDER HOME AND COMMUNITY-BASED WAIVERS. The resident's rights in section 144G.91, subdivisions 12, 13, and 18, may be restricted for an individual resident only if determined necessary for health and safety reasons identified by the facility through an initial assessment or reassessment under section 144G.70, subdivision 2, and documented in the written service plan under section 144G.70, subdivision 4. Any restrictions of those rights for people served under chapter 256S and section 256B.49 must be documented by the case manager in the resident's coordinated service and support plan (CSSP), as defined in sections 256B.49, subdivision 15, and 256S.10. Nothing in this section affects other laws applicable to or prohibiting restrictions on the resident's rights in section 144G.91, subdivisions 12, 13, and 18. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.92 RETALIATION PROHIBITED. Subdivision 1. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person acting on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the director or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law; (6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or
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(9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 2. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; or (7) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices. Subd. 3. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken or threatened by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination. Subd. 4. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 2 within 30 days of an initial action described in subdivision 1, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred. Subd. 5. Other laws. Nothing in this section affects the rights available to a resident under section 626.557. History: 2019 c 60 art 1 s 42,47
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NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 42, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 42, the effective date. 144G.93 CONSUMER ADVOCACY AND LEGAL SERVICES. Upon execution of an assisted living contract, every facility must provide the resident with the names and contact information, including telephone numbers and e-mail addresses, of: (1) nonprofit organizations that provide advocacy or legal services to residents including but not limited to the designated protection and advocacy organization in Minnesota that provides advice and representation to individuals with disabilities; and (2) the Office of Ombudsman for Long-Term Care, including both the state and regional contact information. History: 2019 c 60 art 1 s 43,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 43, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 43, the effective date. 144G.95 OFFICE OF OMBUDSMAN FOR LONG-TERM CARE. Subdivision 1. Immunity from liability. The Office of Ombudsman for Long-Term Care and representatives of the office are immune from liability for conduct described in section 256.9742, subdivision 2. Subd. 2. Data classification. All forms and notices received by the Office of Ombudsman for Long-Term Care under this chapter are classified under section 256.9744. History: 2019 c 60 art 1 s 32,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 32, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 32, the effective date. 144G.9999 RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT TASK FORCE. Subdivision 1. Establishment. The commissioner shall establish a Resident Quality of Care and Outcomes Improvement Task Force to examine and make recommendations, on an ongoing basis, on how to apply proven safety and quality improvement practices and infrastructure to settings and providers that provide long-term services and supports. Subd. 2. Membership. The task force shall include representation from: (1) nonprofit Minnesota-based organizations dedicated to patient safety or innovation in health care safety and quality; (2) Department of Health staff with expertise in issues related to safety and adverse health events; (3) consumer organizations; (4) direct care providers or their representatives; (5) organizations representing long-term care providers and home care providers in Minnesota; (6) the ombudsman for long-term care or a designee;
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(7) national patient safety experts; and (8) other experts in the safety and quality improvement field. The task force shall have at least one public member who either is or has been a resident in an assisted living setting and one public member who has or had a family member living in an assisted living setting. The membership shall be voluntary except that public members may be reimbursed under section 15.059, subdivision 3. Subd. 3. Recommendations. The task force shall periodically provide recommendations to the commissioner and the legislature on changes needed to promote safety and quality improvement practices in long-term care settings and with long-term care providers. The task force shall meet no fewer than four times per year. The task force shall be established by July 1, 2020. History: 2019 c 60 art 1 s 40,47
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Assisted Living Licensure in Minnesota: Frequently Asked Questions November 20, 2020
Background The 2019 Minnesota Legislature enacted a law creating new licensing requirements for assisted living in Minnesota. The new Assisted Living Licensure laws can be found here: 2020 Minnesota Statutes Chapter 144G. Assisted Living (www.revisor.mn.gov/statutes/cite/144G). Assisted Living Licensure goes into effect Aug. 1, 2021 and applies to: ▪ Current and future facilities providing assisted living services and sleeping accommodations. ▪ Arranged home care providers in a housing with services (HWS) establishment. HWS designation will no longer be available as of Aug. 1, 2021. ▪ Providers of customized living services under the Elderly Waiver (EW), Brain Injury (BI), or Community Access for Disability Inclusion (CADI) waiver (exemptions are listed below). ▪ Organizations planning to provide assisted living services and/or customized living services in Minnesota (exemptions are listed below).
Frequently Asked Questions Basic Information and Instructions How do I know whether or not I need to apply for an Assisted Living License? If you intend to operate a facility that offers sleeping accommodations and assisted living services, either with or without dementia care, on or after Aug. 1, 2021, you must apply for an Assisted Living License. You will be prohibited from operating such a facility on or after Aug. 1, 2021, unless you have an Assisted Living License. Refer to “Background” section above. Certain housing settings are exempt from Assisted Living Facility Licensure, meaning an assisted living license is not required. Those settings are listed here: 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 10, paragraphs (1-10) (www.revisor.mn.gov/statutes/cite/144G.08). HWS establishments will sunset after Assisted Living Licensure is implemented on Aug. 1, 2021. After that date, the housing or services CANNOT be called “Assisted Living” unless the building is licensed as an assisted living facility under 2020 Minnesota Statutes 144G, sections 144G.08 through 144G.9999. Also note, providers of the Home and Community-Based Services (HCBS) waiver service of customized living services must have an assisted living license to continue delivering customized living services. This applies to the following waiver programs: 1
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Elderly Waiver (EW) Brain Injury (BI) Community Access for Disability Inclusion (CADI)
Finally, there are a limited number of customized living settings that are excluded from Assisted Living Licensure. These settings may continue to deliver customized living services, pending federal approval. The list of excluded settings include: ▪ Public Housing Buildings and Developments ▪ Section 202 (elderly) Multi-Family Buildings ▪ Section 811 (disability) Multi-Family Buildings These settings are excluded from Assisted Living Licensure: 2020 Minnesota Statutes 144G.08 Definitions: Subdivision 7, paragraphs (11-13) (www.revisor.mn.gov/statutes/cite/144G.08).
Will I still be able to use my Basic or Comprehensive Home Care License to provide other (non-customized living) services? Yes. Refer to: 2020 Minnesota Statutes 144A. Nursing Homes and Home Care (www.revisor.mn.gov/statutes/cite/144A), which will continue. If you plan to provide any services that fall under assisted living services found here: 2020 Minnesota Statutes 144G.08 Definitions: Subdivision 9 (www.revisor.mn.gov/statutes/cite/144G.08), you must have an Assisted Living License.
Will I be able to continue to renew my Basic or Comprehensive Home Care License? Yes
Where can I obtain an Assisted Living License application? Applications are not yet available. MDH plans to begin the application process on or around May 1, 2021. At that time, applications will be available on the MDH website.
As a HWS provider, what should I do if I have not been issued a 2020-2021 HWS certificate by the date that I need to apply for the new Assisted Living License? At this time, MDH has suspended HWS renewals due to the Covid-19 pandemic. Please check: MDH Housing with Services Establishments/Assisted Living Designation/Uniform Consurmer Information Guide (www.health.state.mn.us/facilities/regulation/hws/index.html ) for updates on the status of HWS renewal restart date. A HWS registration that expired on or after April 8, 2020, while in good standing, is considered in effect until the registrant has been notified otherwise by MDH.
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What is the fee for an Assisted Living License? The fee structure for the new license will be: ▪ Assisted Living Facility License = $2,000 plus $75 per resident ▪ Assisted Living Facility with Dementia Care License = $3,000 plus $100 per resident
What is the deadline by which to apply for a HWS registration that is not subject to the new Assisted Living Licensure requirements? On Aug. 1, 2021, the HWS registration will no longer be in effect. At this time, MDH has suspended HWS renewals due to the Covid-19 pandemic. Please check: MDH Housing with Services Establishments/Assisted Living Designation/Uniform Consurmer Information Guide (www.health.state.mn.us/facilities/regulation/hws/index.html ) for updates on the status of HWS renewal restart date. If you wish to continue as an assisted living facility providing assisted living services on Aug. 1, 2021, you must apply for an Assisted Living License. An Assisted Living License must be obtained prior to providing assisted living services.
Currently, the Department of Human Services (DHS) Provider Eligibility and Compliance, enrolls customized living services providers under the EIN and information of the comprehensive license holder, rather than the HWS registrant. Should I be applying for an Assisted Living License with the information of the current comprehensive license holder, or the information of the current HWS registrant? You will use your HWS HFID information.
Do I need to develop policies and procedures for the Assisted Living Licensure? Yes, in order to obtain and retain an Assisted Living License, you must develop assisted living policies and plans as outlined by the statute.
What are the new requirements to customized living facilities? Providers of HCBS waiver service of customized living services must have an Assisted Living License to continue delivering customized living services. This applies to the following waiver programs: ▪ Elderly Waiver (EW) ▪ Brain Injury (BI) ▪ Community Access for Disability Inclusion (CADI) There are a limited number of customized living settings that are excluded from Assisted Living Licensure. These settings may continue to deliver customized living services, pending federal approval. The list of excluded settings include: 3
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Public Housing Buildings and Developments Section 202 (elderly) Multi-Family Buildings Section 811 (disability) Multi-Family Buildings
These settings are excluded from Assisted Living Licensure under: 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 7, paragraphs (11-13) (www.revisor.mn.gov/statutes/cite/144G.08).
What happens to my HWS business if I don’t have an Assisted Living License? You can no longer provide or advertise assisted living services without an Assisted Living License after Aug. 1, 2021. The facility will be subject to misdemeanor penalties for operating after license expiration.
Where do I find more information about resident notices of termination, moves, closure, and coordinated planning? MDH will provide ongoing updates to assist you through these events.
What will the new survey process look like? MDH is currently developing survey documents for survey licensure which will be shared upon completion.
When will the new survey process begin? Immediately upon the new Assisted Living Licensure becoming effective on Aug. 1, 2021.
What will enforcement look like? Are there new consequences (penalties/fines)? Enforcement: 2020 Minnesota Statutes 144G.20 Enforcement (www.revisor.mn.gov/statutes/cite/144G.20) Violations and Fines: 2020 Minnesota Statutes 144G.31 Violations and Fines (www.revisor.mn.gov/statutes/cite/144G.31)
What are residents’ rights and protections? Effective Aug. 1, 2021: 2020 Minnesota Statutes; Resident Rights and Protections (144G.90144G.9999) (www.revisor.mn.gov/statutes/cite/144G.31) and 2020 Minnesota Statutes 144G.07 Retaliation Prohibited (www.revisor.mn.gov/statutes/cite/144G.07) Effective through July 31, 2021: 2020 Minnesota Statutes 144A.44 Home Care Bill of Rights (www.revisor.mn.gov/statutes/cite/144A.44)
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What questions should residents/caregivers ask providers/prospective providers? MDH will be developing a resource to assist residents and their loved ones to navigate the transition to Assisted Living Licensure.
Standards & Requirements Do I need to be licensed as an Assisted Living Facility if I have residents receiving customized living services and on a Medicaid waiver? Yes, if you are providing assisted living services to those residents and are not exempt under 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 7 (www.revisor.mn.gov/statutes/cite/144G.08). You will need an Assisted Living License if you plan to deliver these services to any new or existing residents on or after Aug. 1, 2021.
Do I need to be Medicaid certified to be licensed as an Assisted Living Facility? No. You are not required to be enrolled with DHS in order to be licensed as an assisted living facility. However, you are required to be enrolled with DHS, and be licensed as an assisted living provider through MDH, if you plan to deliver customized living services to people on HCBS waivers.
If I am already a licensed home care provider or a registered HWS facility, do I need to complete another background study? Potentially, yes. Any new individuals listed on the assisted living facility application, who have a direct ownership interest in the license or who are controlling individuals; including managerial officials, are subject to background study requirements. No individual may be involved in the management, operation, or control of an assisted living facility if the individual has been disqualified under 2020 Minnesota Statutes Chapter 245C. Human Services Background Studies (www.revisor.mn.gov/statutes/cite/245C). Current direct care staff who already have a completed background study do not need to repeat it.
What are the staffing requirements for the Assisted Living License? 2020 Minnesota Statutes 144G.60 Staffing Requirements (www.revisor.mn.gov/statutes/cite/144G.60).
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Do I need to hire a Licensed Assisted Living Director? Yes. See 2020 Minnesota Statutes 144G.08 Definitions; Subdivision 6 (www.revisor.mn.gov/statutes/cite/144G.08) and 2020 Minnesota Statutes 144A.20 Administrator Qualifications; Subdivision 4 (www.revisor.mn.gov/statutes/cite/144A.20).
Can the director and the clinical nurse supervisor be the same person? Yes, as long as the individual holds the proper licenses for each role.
What are the new training requirements for Assisted Living Staff? See: 2020 Minnesota Statutes 144G.63 Orientation and Annual Training Requirements (www.revisor.mn.gov/statutes/cite/144G.63) for assisted living and 2020 Minnesota Statutes 144G.64 Training in Dementia Care Required (www.revisor.mn.gov/statutes/cite/144G.64) for assisted living with dementia care.
What "experience" is required for an Assisted Living Dementia Care applicant (or consultant)? See: 2020 Minnesota Statutes 144G.80 Additional Licensing Requirements for Assisted Living Facilities with Dementia Care (www.revisor.mn.gov/statutes/cite/144G.80) and 2020 Minnesota Statutes 144G.83 Additional Training Requirements for Assisted Living Facilities with Dementia Care (www.revisor.mn.gov/statutes/cite/144G.83). MDH continues to develop more guidance around this topic.
If I have multiple buildings that house residents, how many licenses do I need? As of now, one license per physical address. Some exceptions exist for properties that consist of more than one building on a single property, or two or more buildings at different addresses which share a portion of a legal property boundary. See Proposed Rules 4659 Licensing in General: Assisted Living Facilities Proposed Rules (PDF) (www.health.state.mn.us/facilities/regulation/AssistedLiving/docs/proposedrules100820.pdf)
If I am converting to the new Assisted Living Licensure, what are the physical plant requirements? See: 2020 Minnesota Statutes 144G.45 Minimum Site, Physical Environment, and Fire Safety Requirements (www.revisor.mn.gov/statutes/cite/144G.45). MDH continues to develop more guidance around this topic.
What will the food code compliance expectations be? See: 2020 Minnesota Statutes 144G.41 Minimum Assisted Living Facility Requirements; Subdivision 1, Paragragh (13) (www.revisor.mn.gov/statutes/cite/144G.41) for food code requirements. 6
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Can I accept Assisted Living residents before I get my new Assisted Living License? You may continue to provide services under 2020 Minnesota Statutes 144A. Nursing Homes and Home Care (www.revisor.mn.gov/statutes/cite/144A.20) until Aug. 1, 2021. You may not provide assisted living services under 2020 Minnesota Statutes 144G. Assisted Living (www.revisor.mn.gov/statutes/cite/144G.41) until Aug. 1, 2021.
How can I ensure that our new construction/new building(s) are in compliance with new Assisted Living requirements? See: 2020 Minnesota Statutes 144G.45 Minimum Site, Physical Environment, and Fire Safety Requirements (www.revisor.mn.gov/statutes/cite/144G.45) for information on physical plant requirements.
Can I submit my construction plans for MDH to review prior to Aug. 1, 2021? No. At this time the new Assisted Living Licensure statues do not allow for plan review prior to Aug. 1, 2021. MDH is in further discussion surrounding this topic.
How will changes in ownership (CHOWs) be handled during this transition? CHOW sales must be finalized prior to Aug. 1, 2021. An Assisted Living License may not be transferred to another party. See: 2020 Minnesota Statutes 144G.19 Transfer of License Prohibited (www.revisor.mn.gov/statutes/cite/144G.19) for more information. Further guidance is currently being developed by MDH on this topic.
When will I get surveyed for the Assisted Living License? Per 2020 Minnesota Statutes 144G.16 Provisional License; Subdivision 2 Initial Survey (www.revisor.mn.gov/statutes/cite/144G.16), within 60 days of notice of having a resident receiving services and at a minimum of once every two years after Aug. 1, 2021.
What is the new licensing and renewal process? New applicants: 2020 Minnesota Statutes 144G.12 Applicaiton for Licensure (www.revisor.mn.gov/statutes/cite/144G.12). Renewals: 2020 Minnesota Statutes 144G.17 License Renewal (www.revisor.mn.gov/statutes/cite/144G.17).
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ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS
Troubleshooting Issues How do I get a licensed director when BELTSS (Board of Executives for Long Term Services and Supports) isn’t licensing at this time? This situation is under discussion and more information will be forthcoming.
I submitted an application/registration, but I haven’t heard back from MDH? During COVID, under the Minnesota Governor’s Executive Order 20-32, MDH suspended license applications reviews. MDH will provide notification when the application/registration process is restarted.
How will I be allowed to promote my Assisted Living Facility? You must have an assisted living license to advertise as an assisted living provider. You must have an assisted living with dementia care license to advertise and provide specialized care for dementia related diagnoses.
I have already applied for a HWS registration, but MDH has not processed it yet. Can I be grandfathered in? During COVID, under the Minnesota Governor’s Executive Order 20-32, MDH suspended license and HWS registrations reviews. MDH will provide notification when the review process is restarted.
If I have not paid fines by my next renewal date, is outstanding debt a reason for revoking or not re-licensing? Yes, outstanding debts may be a reason for not renewing a license.
Next Steps We encourage you to read the new Assisted Living Licensure laws: 2020 Minnesota Statutes Chapter 144G. Assisted Living (www.revisor.mn.gov/statutes/cite/144G). Please visit the Assisted Living Home Page on the MDH Website to review the Assisted Living Facilities Licensure proposed rules: Assisted Living Facilities Proposed Rules (PDF) (www.health.state.mn.us/facilities/regulation/AssistedLiving/docs/proposedrules100820.pdf) Before the end of 2020, a Notice of Hearing regarding the proposed rules will be posted. You will have at least 30 days to provide comments regarding these proposed rules prior to the Office of Administrative Hearing process. Questions about an existing HWS registration should be directed to the Health Regulation Division’s (HRD) HWS team: health.HWS@state.mn.us 8
ASSISTED LIVING LICENSURE IN MINNESOTA: FREQUENTLY ASKED QUESTIONS
Questions about an existing Home Care license should be directed to HRD’s Home Care and Assisted Living Program (HCALP) team: health.assistedLiving@state.mn.us
Additional Resources Additional sources of information regarding Assisted Living Licensure in Minnesota include: ▪ 2020 Minnesota Statutes 144G.02 Assisted Living; Subdivision 1. Protected title, restriction on use (www.revisor.mn.gov/statutes/cite/144G.02) ▪
Minnesota Department of Health Assisted Living Home Page (www.health.state.mn.us/assistedLiving)
▪
Assisted Living Licensure in Minnesota Fact Sheet (PDF) (www.health.state.mn.us/facilities/regulation/assistedLiving/docs/factsheet.pdf)
▪
Assisted Living Licensure in Minnesota Making the Transition (PDF) (www.health.state.mn.us/facilities/regulation/assistedLiving/docs/transitionfs.pdf)
Minnesota Department of Health Health Regulation Division PO Box 64900 St. Paul, MN 55164-0900 651-539-3049 or 844-926-1061 health.assistedliving@state.mn.us www.health.state.mn.us/assistedliving
11/23/2020 To obtain this information in a different format, call: 651-201-4101.
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PERSONALIZED DEMENTIA CARE—BRIDGING THE GAP BETWEEN THE PERSON-CENTERED APPROACH & THE HUMAN EXPERIENCE March 3, 2021
Krisie Barron, LSW, Caregiver Specialist Embrace, Inc.
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Thank you to our sponsor
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The only test you should order for your patient is the one that could lead to a better outcome
Vikor Scientific is a molecular diagnostic company that is solving the antibiotic crisis that we are facing in the United States. Vikor Scientific is a high complexity CLIA-certified and CAP-accredited laboratory based in Charleston, South Carolina. • Due to Vikor’s extensive pathogen panel, we currently offer the following panels based off your patient’s symptoms • Respira-ID (swab) • Vaginal-ID (swab) • Urine-ID (swab based – can be done by dipping in sterile cup, wet briefs/bed sheets) no minimum amount required, does not need to be refrigerated or stored. • Nail-ID (nail clippings/shavings) • Wound-ID (swab or tissue sample) • Vikor has a 24 hour turnaround-time and an accuracy of 99.8% in pathogen identification. This is then reflexed to 49 antibiotic genes letting you know what your patient is antibiotic resistant to. This allows savings on additional costs on unnecessary antibiotics, additional costs on future office visits, and ultimately changing a patient’s outcome. • Vikor has 22 world-class infectious disease trained PharmD’s led by Dr. Robin Prince. Her team is available around the clock for consultations. • Vikor testing is covered by Medicare and Medicaid at 100%. • Finally, the testing is FREE OF CHARGE to your facilities with NO CONTRACTS. We are an as needed service. Vikor provides the testing kits (all swab based) as well at the prepaid FedEx packaging for shipping to our lab. We bill insurance so there is no excess billing required by your staff with one of the most compassionate billing systems in the world! • Vikor Scientific exists to help clinicians bring the best possible care to their patients and improve patient outcomes.
VIKOR SCIENTIFIC, LLC 22 WestEdge Street, 8th Floor Charleston, SC 29403
Phone: 854-429-1069
www.vikorscientific.com
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PERSONALIZED DEMENTIA CARE BRIDGING THE GAP BETWEEN THE PERSONCENTERED APPROACH & THE HUMAN EXPERIENCE
KRISIE BARRON LSW CARE PARTNER SPECIALIST
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INTRODUCTIONS
Krisie Barron, LSW, Care Partner Specialist Embrace, Inc. Krisie Barron is a Licensed Social Worker and Caregiver Specialist who practices extensively in supporting Family and Professional Caregivers. Through her ongoing education, 20 years of experience in Long Term Care, Home and Community Based Services and her own personal journey as a Caregiver for her husband, she brings a unique and all-encompassing outlook and understanding of supporting Caregivers as well as being supported. Krisie believes that “How we start…dictates where we end."
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Tactical Breathing (The Marines do it…) 3 deep breaths Each Breath… in for 4 hold for 4 out for 4 hold for 4
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IF YOUR HERO SHOWED UP TODAY… WHAT COULD THEY DO FOR YOU TO MAKE YOUR DAY BETTER?
30 Second Quick List…
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What is one thing you need me to know about you to care for you in a way that is Comfortable and Familiar to You? Example:
What is the most important part of your morning routine?
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How we start…
Dictates where we end… ~Krisie Barron LSW Caregiver Specialist
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How many people see you as their Hero?
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Pick a Person Living with Dementia who you are struggling with.
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Connecting to the “Humanness” of me… • • • • • • • •
Who I am and my perception of life… Where I come from life experiences… Who is important to me... What is important to me... Current Quality of Life… Fears… What is the best way support me… What makes life worth living...
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https://slideshare/com
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POSITRON EMISSION TOMOGRAPHY (PET) ALZHEIMER’S DISEASE PROGRESSION VS. NORMAL BRAINS Normal
Early Alzheimer’s
Late Alzheimer’s
Child
G. Small, UCLA School of Medicine.
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The primitive brain is in charge of: •Survival -Autonomic protective: fright, flight, fight, or hide and seek Pleasure-seeking: meeting survival needs and finding joy •Thriving: Running the Engine -Maintain vital systems (BP, BS, Oxygen Saturation, Temperature, Pain) -Breathe, suck, swallow, digest, void, defecate -Circadian rhythm -Infection control •Learning New and Remembering: -Information -Places: spatial orientation -Passage of time: temporal orientation
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What happens when your lid pops off? 4 Fingers are your Executive Control Center Thinking Brain Rational and Wise
Thumb is your Amygdala Emotional Control Center Threat Response Fight – Fright Flight
Wrist is your Brain Stem In charge of basic bodily functions
Dr. Dan Seagle
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Anxiety – Uncertainty Disappointment – Unmet Expectations Anger – Injustice Fear – Impending Danger Joy – Achieving a Goal
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Extrovert • • • • • • • •
Needs time with others to explore thoughts/feelings Benefits from collaboration Will seek approval and opinion of others Spending time with people reenergize Will think out loud and ask questions Likes intimacy: prefers to share space Boundaries are flexible: seeks work/life balance Processes externally: connection trumps control
Introvert • • • • • • • •
Needs time alone to think and feel Benefits from preparation time Will tend to self-assess May become quiet or retreat under stress Decisions tend to be final Likes privacy: also applies to belongings Needs boundaries: keeps home/work separate Processes internally: likes a sense of control
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Pause for the Cause Supporting Ourselves in the Moment… Questions the anger and making it your ally… Anger inspires action… Anger needs us to see clearly and take action; but it’s hard to do when your emotional brain is in charge and not your thinking brain… A path to making Anger your ally is to bet back to your thinking brain. 4 fingers of your hand represents your thinking brain.. 1. 2. 3. 4.
Breath Name It… mad mad mad angry sad Do it differently… Growl, give it the finger, stomp it off Inquire… Talk to the anger ask a genuine question…
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We live by our BOX OF STORIES… Identity Beliefs Assumptions
How I see Myself…
How I see my reality…
How I see you… 22
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RECOGNIZING THE STORY WE ARE TELLING OURSELVES…
What is the story we are telling ourselves? How we see the world around us shifts base on our emotions and the stories we tell ourselves.
Sorting it all out R.U.L.E.R Dr. Marc Brackett R U L E R
– – – – –
Recognizing emotions in self and others Understanding the emotion – cause and consequence of our feelings Labeling – how much or how little of the emotion Expressing our feeling – Someone to listen Regulating our feelings – Our strategy to handle the emotions
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GOING FROM WAR TO PEACE… FROM JUDGEMENT TO CURIOSITY… EXTENDING GRACE…
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War and Peace
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Positive Approach to Care (PAC) Beliefs o The Relationship is MOST critical, NOT the outcome of one encounter. o We are the KEY to making life worth living. o People living with Dementia are doing the BEST they can. o We must be willing to change OURSELVES
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Care Partner
Caregiver
Power Over
Power With
© TLC-PCP 2012 www.learningcommunity.us
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www.teepasnow.com
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Dementia Equals…
The person’s brain is dying 29
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Normal Brain
Alzheimer’s Brain
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VISION CENTER – BIG CHANGES
With each new level of vision change, there is a decrease in safety awareness. 1. 2. 3. 4. 5. 6.
Less Peripheral Awareness Tunnel Vision Binocular Vision Object Use Confusion Monocular Vision Limited Visual Regard
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HEARING OF SOUND – NOT CHANGED
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UNDERSTANDING LANGUAGE – BIG CHANGE
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Sensory Strip Motor Strip White Matter Connections BIG CHANGES Automatic Speech Rhythm – Music Expletives PRESERVED Formal Speech & Language Center HUGE CHANGES
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Executive Control Center • • • • • • • •
Emotions Behavior Judgment Reasoning Impulse Control Be Logical Make Choices Start-Sequence-Complete-Move On Self Awareness See Others’ Point of View
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Hippocampus BIG CHANGE Learning & Memory Center • • •
Way finding Time Awareness Learning & Memory
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Positive Personal Connections (PPC): 1. Greet or Meet: Introduce yourself, use their preferred name. “Hi ____, I am ____” or “I am ____ and you are ____?” 2. Say Something Nice: Indicate something about them of value. “That is a beautiful shirt!” 3. Be Friendly: Share about yourself, then leave some silence. “My daughter’s name is the same as yours! I’ve got three daughters.” 4. Notice Something: Point out something in the environment. “Have you seen the new plants they put in the front room?” 5. Be Curious: Explore a possible unmet like, need or want. “Would you like to listen to some music?”
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Positive Action Starters (PAS): 1. Help: Compliment their skill in this area, then ask for help. “You’re so handy with puzzles, could you help me with this one?” 2. Try: Hold up or point to the item you would like to use, possibly sharing in the dislike of the item or task. “Well, let’s try this. I’ve never really liked brushing my teeth either!” 3. Choice: Try using visual cues to offer two possibilities or one choice with something else as the other option. “Should we wear the red shirt or the blue shirt today?” 4. Short and Simple: Give only the first piece of information. “It’s about time to get our shoes on.” 5. Step by Step: Only give a small part of the task at first. “Lean forward.”
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THE BASICS FOR SUCCESS •
Be a Detective NOT a Judge
•
Look, Listen, Offer, Think…
•
Use Your Approach as a Screening Tool
•
Always use this sequence for CUES
•
Visual - Show
Verbal - Tell
Physical – Touch
Match your help to remaining abilities
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Top Five Unmet Needs: Physical Needs: Hydration and Nourishment Wake-sleep and active-rest cycles Elimination: all forms Pain-free: • Physical – body • Emotional – relationships • Spiritual – belonging/purpose Signals of Emotional Distress: • Angry • Sad • Lonely Scared • Bored/Lacking Purpose
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APPROACH MATTERS Use a consistent Positive Physical Approach™
Pause at edge of public space
Gesture and greet by name
Offer your hand and make eye contact
Approach slowly within visual range
Shake hands and maintain Hand-Under-Hand™
Move to the side
Get to eye level & respect intimate space
Wait for acknowledgement
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WHEN WORDS DON’T WORK WELL Hand-under-Hand™ •
Uses established nerve pathways
•
Allows the person to feel in control
•
Connects you to the person
•
Allows you to DO with not to
•
Gives you advance notice of ‘possible problems’
•
Connects eye-hand skills
•
Use the dominant side of the person
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FOR ALL COMMUNICATION If what you are trying is NOT working… •
STOP
•
Back off
•
THINK IT THROUGH…
•
Then, re-approach
•
And try something slightly different
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Ruh-ro Ruh-ro
Ruh-ro
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2021 Housing & Nurse Managers' Education Series
GROWING A HEALTHY RELATIONSHIP HOUSING MANAGERS & NURSE MANAGERS March 10, 2021
Amanda Johnson, RN, LNHA, CHC, Vice President of Clinical Operations, Chief Compliance Officer Tealwood Senior Living
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Thank you to our sponsor
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We’ve got you covered. Improve Resident Outcomes Create Workforce Efficiencies Further Your Financial Objectives
Over the past 20 years, Eldermark has become the leading electronic health record and operational technology solution for the senior care industry—and for good reason. We don’t offer piecemeal healthcare management solutions. Rather, we partner with senior living organizations to develop a comprehensive, mobile-friendly healthcare, communications, and business operations software platform that saves you time and money while raising the quality of care you provide. 100% user-ready for the 2021 MN Assisted Living Licensure requirements Eldermark Senior Housing Software 12400 Whitewater Drive Suite 2010 Minnetonka, MN 55343
Phone: 952-931-9660 repsales@eldermark.com
eldermark.com
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GROWING A HEALTHY RELATIONSHIP - HOUSING MANAGERS & NURSE MANAGERS Care Providers of Minnesota 2021 Housing Managers/Nurse Managers Education Series
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INTRODUCTIONS Amanda Johnson, RN, LNHA, CHC, Vice President of Clinical Operations, Chief Compliance Officer Tealwood Senior Living Ms. Johnson has worked in long term care since 1989. She holds a bachelor's degree in human services from the University of MN, Morris. She is a registered nurse and a licensed nursing home administrator. At Tealwood Senior Living her responsibilities include developing skilled nursing, housing and home care policy and procedures, health information technology, regulatory compliance, corporate compliance, collaborative performance improvement projects, multiple aspects of quality improvement, and overall company leadership. In addition to clinical oversight, Ms. Johnson also oversees operations for several properties within the Tealwood portfolio. She currently serves as Vice Chair of the Care Providers of MN Board of Directors, sits on the Long-Term Care Imperative Steering Committee, and was appointed to the MN state Board of Executives for Long Term Services and Supports (formally BENHA). Ms. Johnson has served on several committees with Care Providers of Minnesota and is a frequent speaker on regulatory, leadership, reimbursement and other industry related topics.
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TODAY’S GOALS
UNDERSTAND THE RELATIONSHIP BETWEEN HOUSING MANAGEMENT AND NURSING MANAGEMENT
IDENTIFY THE KEY SYSTEMS OF ASSISTED LIVING
DISCUSS THE RISK AREAS OF EACH
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MANAGER 101 A new manager spends a week at his new office with the manager he is replacing. On the last day the departing manager tells him, "I have left three numbered envelopes in the desk drawer. Open an envelope if you encounter a crisis you can't solve." Three months down the track there is a major drama, everything goes wrong - the usual stuff - and the manager feels very threatened by it all. He remembers the parting words of his predecessor and opens the first envelope. The message inside says "Blame your predecessor!" He does this and gets off the hook. About half a year later, the company is experiencing a dip in sales, combined with serious product problems. The manager quickly opens the second envelope. The message read, "Reorganize!" This he does, and the company quickly rebounds. Three months later, at his next crisis, he opens the third envelope. The message inside says "Prepare three envelopes".
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POLL Do you have a good relationship with your housing or nurse manager? •Yes, I am housing manager •No, I am housing manager •Yes, I am nurse manager •No, I am nurse manager •Other, add to chat box
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POLL Does your housing or nurse manager understand your role? •Yes, I am housing manager •No, I am housing manager •Yes, I am nurse manager •No, I am nurse manager •Other, add to chat box
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HOW DO YOU DO BUSINESS?
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WHO IS WATCHING HOW YOU OPERATE? • OLDER ADULT SERVICES
• TENANT LANDLORD LAWS
• MN BOARD OF NURSING
• HOUSING WITH SERVICES
• STANDARDS OF CARE
• FOOD AND LODGING
• EMPLOYMENT LAWS/STANDARDS • STATE AND FEDERAL REGULATIONS
• OSHA (MN LABOR AND INDUSTRY)
• CORPORATE POLICY AND PROCEDURES • FACILITY POLICY AND PROCEDURES • CUSTOMERS/CONSUMERS/ADVOCATES
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WHO ELSE IS WATCHING...? EVERYONE!!!
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Because you call yourself Assisted Living
WHY DO I NEED A NURSE?
• Must offer to provide or make available health related
services under any license
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RN on-call, accessible to staff 24/7
MN 144G = WHY YOU NEED A NURSE
A system to check on each AL client at least daily A means for clients to request assistance with health/safety needs 24/7 Offer to have a nursing assessment and propose a service plan/agreement prior to the execution of a lease
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DUTIES THAT ARE OFTEN SHARED • HR DIRECTOR • FAMILY COUNSELOR • STAFF COUNSELOR • MAINTENANCE • TEACHER • ADMINISTRATOR • ACCOUNTANT • NEGOTIATOR • WASTE MANAGERS
• NURSING DELEGATION IS NOT A SERVICE THAT CAN BE SHARED
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COMMON THEMES AND TERMS • RENTAL AGREEMENT • SERVICE AGREEMENT • ASSESSMENTS • COACHING • TEACHING • DIRECTING • SUPERVISING
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POLL Have you completed leasing/move in paperwork? •Yes, as housing manager •Yes, as nurse manager •Yes, as housing/nurse manager •Yes, as another staff •No
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Pricing structures vary •
Rent/services
•
All inclusive rate- per month or per day
•
Ala carte
•
Tiers or levels
•
Base plus ala carte
•
EW clients – Customized Living Tool
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NURSES DRIVE THE REVENUE
ASSESSMENT
SERVICES
REVENUE
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CLINICAL PROCESS RN assessment/evaluation Service plan: description, delegation, cost Annual reviews Delegation of services Medication administration Supervisions Orientation and training On going assessments
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LEASE
UPDATES
TENANT/ CLIENT= CUSTOMER
SERVICE AGREEMENT
EVALUATION
AN ACTIVE PROCESS 21
ASSISTED LIVING 101 HOUSING/TENANT
HOME CARE/CLIENT
SERVICES
Referral/Intake
Nursing/Admission Assessment
Care Plans-Assignment Sheets
Occupancy Agreement
Service Agreements/ Modifications
Re-Evaluation Plan
Eviction Notice
Supervisions
Discharge Plan Termination of Services
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WHO TELLS NURSES WHAT TO DO? MN Board of Nursing State and Federal regulations Corporate/Facility policy and procedures Standards of care Home Care Directors Administrators Do you?????
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Systems Manager- implement, train, delegate, synthesize Medications manager- not primarily setting up meds, utilizing others for MAR entry and or pharmacy communication Supervisor of personnel Relationship with Housing Director or Manager DELEGATION OF DUTIES
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HR management Referrals Social Worker
AND DON’T FORGET…
Recreational Therapy Teacher Counselor Maintenance LOOK FAMILIAR?
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WHAT DO THE NURSES DO?
Assessment: related to functional, physical, cognitive and supportive status of the resident
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WHEN DO THEY COMPLETE THEM? • Prior to move-in • Upon admission to services • With significant changes in condition/service needs • Annually from admission date AND THINGS ARE HEATING UP
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Care planning:
THEN WHAT DO THEY DO?
using information gathered during the assessment process, development of a care plan, communication of the care to the resident, family and staff & oversight of the care implementation by staff and recognition of deviation from the plan
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Establish level of service/package needs
SERVICE PLANS = REVENUE
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Need to be clear to consumer
Agency Policies and Procedures must be consistent
Not 24 hr. skilled nursing Adequate staff
Example: How is your staff directed to respond in case of a tenant/resident fall?
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Medication management:
IS THAT ALL? testing of residents to determine ability for selfadministration of medication, oversight of medication storage and administration
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POLL Have you completed home health aide/resident assistance training at your current community? •Yes •No •In the process
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Basis for most services in home care/assisted living
Each nurse in responsible for their own license
RN DELEGATION
Non-licensed or certified personnel performing tasks
Nurse Practice Act and Standards of Practice
Training Competency Skills
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Need clear and consistent documentation
NURSING DELEGATION
Return competency when appropriate Timely Reviewed with performance issues, annually Maintain records
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Staff orientation
Supervisions
In-services
Infection control
ANYTHING ELSE?
Safety
Standards of practice
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Know the Language
WHAT ELSE SHOULD I KNOW?
Home Health Aide Delegation Supervision Medication Reminders/Assistance/Administration ADLs Dressing, Grooming, Bathing Toileting, Transfer assistance
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Know How You are Getting Paid
SO WHAT SHOULD I KNOW?
Private LTC Insurance EW Customized Living Tool GRH
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Narcotics- storage, diversion prevention Service Plans/Agreements
HOT TOPICS
Reassessments Staff Training Medication Administration
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DON’T GET CAUGHT BY SURPRISE Know Your Team-who is doing the hiring? Who works with you? Turnover? Know Your Customers-meet families, tenants, case managers etc. Know Your Systems- med administration, narcotics, falls, med errors, change in conditions, sit through training Know Your Strengths-licensed staff levels, direct care levels, memory care, extensive services, supervised living Know Your Weakness- untrained staff, meal service, staffing levels Know Your Risk Areas- medications administration, narcotic diversions, employee injury, needle sticks, hazardous waste
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Includes training, monitoring, oversight of delegated administration Systems for security of all medications- especially controlled substances
MEDICATION MANAGEMENT
Communication with pharmacy, practitioners, families
= BIG DEAL
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POLL Have you have passed medications in your current community? •Yes, as housing manager •Yes, as nurse manager •Yes, as housing/nurse manager •Yes, as another staff •No
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Medication Management and Training Narcotic Management
“KEY OPERATIONAL SYSTEMS
Orientation Monitoring Status Incident Reporting and follow up Assessment/Re-Assessments Competencies
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Consumers need to be clear on your services…so do you and your nurse.
WHAT DOES YOUR FACILITY OFFER?
Assisted Living is NOT required to provide 24-hour skilled care. You must have adequate staff to take care of your clients. Policies and Procedures must be consistent.
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Entrance Criteria
KNOW YOUR REQUIREMENTS
Continued Stay Criteria
Alternative Placement Criteria
BE CONSISTENT!!!
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SERVICE RECOVERY AND MITIGATION
Requires interdisciplinary solutions All hands-on deck approach to resolve Review for common themes, repeat issue ROOT CAUSE RED FLAGS: REPEAT ISSUES FREQUENT INCIDENTS COMMON COMPLAINTS
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Know enough to be dangerous…
PROTECT YOURSELF AND YOUR CUSTOMERS
A Guide to the Survey Process A Guide to Home Care Vulnerable Adult Training Orientation Process Competencies Personnel Files Time Management Work Environment Customer Satisfaction
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You need tenants to have clients Clients need services to stay Services generate revenue Revenue pays the bills Quality services generate customer satisfaction Customer satisfaction generates more tenants
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Corporate Goals & Expectations Multi-facility Ownership Goals & Expectations Stand Alone Facility Goals & Expectations Tenant/Client Goals & Expectations Staff Goals & Expectations Personal Goals & Expectations 48
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Communication
KEYS TO A SUCCESSFUL RELATIONSHIP
Trust Appreciation Knowledge Respect
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QUESTIONS?
Amanda Johnson RN, LNHA Vice President of Clinical Operations Tealwood Senior Living 612-968-5530 amanda.johnson@twsl.com
…because the journey matters
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CLINICAL CARE IN A PANDEMIC March 11, 2021
Cindy Fronning, RN, GERO-BC, IP-BC, AS-BC, CDONA, FACDONA, RAC-CT Director of Education NADONA
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Thank you to our sponsor
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2021 Nurse Managers' Education Series
Empowering Healthcare McKesson's pharmaceutical distribution supply chain, healthcare services, and medical supplies & equipment help address the challenges healthcare organizations face today—and shape how they’ll overcome the new challenges of tomorrow. McKesson Medical‐Surgical
Phone: (800) 328‐8111 Fax: (763) 241‐4033
8121 10th Avenue North Golden Valley, MN 55427
www.mckesson.com 3
Clinical Care in a Pandemic Cindy Fronning RN, GEROBC, IP-BC, AS-BC, CDONA, FACDONA, RAC-CT Director of Education NADONA NADONA 2021
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2021 Nurse Managers' Education Series
INTRODUCTIONS
Cindy Fronning, RN, GERO-BC, IP-BC, AS-BC, CDONA, FACDONA, RAC-CT Director of Education NADONA Cindy has been a DON, a corporate consultant, a national consultant, and is now the director of education for NADONA. Cindy’s experience includes education of nursing facility personnel, mentoring of nurses, clinical systems and form development, department restructuring, and mock surveys. She has extensive experience in Medicare, MDS/RAI process, care planning, implementation of systems, as well as a comprehensive understanding of state and federal regulations. In her current role, she is responsible for the planning, direction, and implementation of all educational projects and pursuits within NADONA.
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Objectives The participant will be able to: 1. Identify the difference between routine care and care rendered during a pandemic 2. Describe the components needed to keep clients and staff as free from infection as possible 3. Explain what is needed when planning for future pandemics
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Providing Care
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Providing Care • Changes to standards of care should take place along a continuum of levels of care: – Conventional: Normal level of healthcare resources; – Contingency: Demand for healthcare resources begins to exceed supply but adaptations are possible to still deliver functionally equivalent care; – Crisis: Resources are exceeded by demand or depleted; functionally equivalent care is no longer possible to address all requirements and there is a risk to client or provider.
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Providing care (Routine/Contingency) • Routine Care •
ADLS • Mobility • Personal Hygiene • Eating • Toileting
• Socialization • •
Internally Externally
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Providing care (Routine/Contingency) cont. • Emotional Support • • • •
Clients Staff Family Friends and Neighbors
• Medical Care • • • • •
Nursing Care – Meds/treatments Therapy (Outside Clinics) Clinics ER Depts Hospitals
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Providing Care – (Crisis situation) • Crisis - Resources are exceeded by demand or depleted; functionally equivalent care is no longer possible to address all requirements and there is a risk to patient/resident or provider
• Care of the clients in crisis • •
Isolation in Apartment / unit ADLS • • • •
•
Mobility Personal Hygiene Eating Toileting
Socialization • •
Internally Externally
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Providing Care – (Crisis situation) cont. •
Emotional Support • • • •
•
Clients Staff Family Friends and Neighbors
Medical Care • • •
Nursing Care – Meds/treatments Therapy – Outside clinics Physician Care • •
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Telemetry Clinics
ER Depts Hospitals
Advanced Directive Discussions
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https://files.asprtracie.hhs.gov/documents/covid-19-considerations-strategies-and-resources-for-crisis-standards-of-care-in-paltcfacilities.pdf
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Keeping Clients Safe and Infection Free
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Keeping Clients Safe & Infection Free •
Accurate Assessments (Daily Rounds) • Check for symptoms at least daily (More frequently if symptomatic) • Examples of Signs & Symptoms: • • • • • • • • • • • • • • •
Temp(Fever >100F) SpO2(%, look for decreasing trends) Changes in conditions without obvious cause Change in Mental status Cough Diarrhea Shortness of breath Chills Repeated shaking with chills Muscle pain Headache Sore throat New loss of taste or smell Extremities for blood clots Changes in skin conditions
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Keeping Clients Safe & Infection Free cont. • Testing –follow CDC and State guidance • Social Distancing • Immediate interventions after infection discovered • Isolation • Testing of others who may have been in contact • Revisit visitor access
• Education • • • •
Re-educate on PPE Hand hygiene Transmission Precautions (Isolation) utilization (WHY) Respiratory Hygiene and Cough Etiquette
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https://www.health.state.mn.us/diseases/coronavirus/hcp/ltctestrec.pdf
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Keeping Staff Safe and Infection Free
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Keeping Staff Safe and Infection Free • Accurate Screening / Testing • Screen all staff prior to start of shift • Temp • Questions regarding potential exposure
• Appropriate PPE • Have necessary PPE quantities available to provide for staff well being
• Repetitive education • • • •
PPE Hand hygiene Transmission Precautions (Isolation) utilization Respiratory Hygiene and Cough Etiquette
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Keeping Staff Safe and Infection Free cont. • Pandemics can be stressful! • Guilt • Fearful • Worried about the health of your loved ones, your financial situation or job, or loss of support services you rely on. • Changes in sleep or eating patterns. • Difficulty sleeping or concentrating. • Worsening of chronic health problems. • Worsening of mental health conditions. • Increased use of tobacco, and/or alcohol and other substances.
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Keeping Staff Safe and Infection Free cont. • Pandemic Outcomes • Post‐Traumatic Stress Disorder (PTSD) • Secondary Traumatic Stress (also know as vicarious traumatization) • Compassion Fatigue • Burnout • Mild to Severe Depression • Suicide
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Keeping Staff Safe and Infection Free cont. • Recognize symptoms • • • • • • • •
Feeling irritation, anger, or denial Feeling uncertain, nervous, or anxious Feeling helpless or powerless Lacking motivation Feeling tired, overwhelmed, or burned out Feeling sad or depressed Having trouble sleeping Having trouble concentrating
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Keeping Staff Safe and Infection Free cont. • Recognizing “Covid” PTSD • Re-experiencing the trauma: A person may have nightmares or experience flashbacks. • Avoiding certain situations: A person may avoid situations or people that remind them of the traumatic experience. • Experiencing negative changes in emotions and beliefs: A person may experience changes in the way they think about themselves and others around them. They may also forget about parts of the event and be unable to experience loving feelings toward others. • Experiencing hyperarousal: Those with PTSD may experience difficulty sleeping and concentrating, and they may become easily startled.
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Keeping Staff Safe and Infection Free cont. • Signs of Secondary Traumatic Stress or Compassion Fatigue • • • • •
Abusing drugs, alcohol or food Anger Blaming Oversensitivity Avoidance or dread of working with certain clients • Chronic lateness NADONA 2021
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Keeping Staff Safe and Infection Free cont. • Signs of Burnout • • • • • • •
Sadness, depression, or apathy Easily frustrated Blaming of others, irritability Lacking feelings, indifferent Isolation or disconnection from others Poor self-care (hygiene) Tired, exhausted or overwhelmed
• Feeling like:
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A failure Nothing you can do will help You are not doing your job well You need alcohol/other drugs to cope
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Keeping Staff Safe and Infection Free cont. • Provide assistance • Provide education on stress and burnout for all staff • Provide avenues in which the employee can feel safe discussing his/her feelings • Provide a vehicle in which the staff member can seek professional assistance
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Planning for the Future/What Have We Learned?
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What Have We Learned?
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Lessons Learned • Supplies • Masks • Isolation carts • Isolation trash cans • Gowns • Gloves • Not usually a supply problem • Vinyl gloves can be very difficult to slip over hands that have been sanitized with alcohol-based sanitizer. Nitrile gloves are much easier to use. • Bleach wipes NADONA 2021
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Lessons Learned cont. • Equipment/Furniture • Bedside Tray tables needed for dining due to no tables in some units • Trays were needed to deliver meals (McDonald’s) • Local restaurants provided perishable foods
• Develop frequent Vital Signs testing for all clients especially Temperature and Pulse Oximetry • TIP: proactively remove fingernail polish from all current clients to enhance pulse oximetry accuracy • Facilities may need to enhance equipment including portable Thermometers and Pulse Oximeters
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Lessons Learned cont. • Method of Communication with Clients / Families • Time consuming but may not have other means • Dedicated phone line/message center • Phone notification • Face Book • Texting
• Activities • •
Doorway Bingo 1:1
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Focused
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https://www.health.state.mn.us/diseases/coronavirus/hcp/ltcvisit.pdf NADONA 2021
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Lessons Learned cont. • Know what Healthcare Coalitions (HCC) are available to you – HCCs are groups of local health care and responder organizations that work together on challenges and find solutions that improve emergency preparedness and the health and safety of their communities – HCCs reflect the unique needs and features of their local areas. They help health care facilities to plan, organize, equip, train, exercise, and evaluate the health care system preparedness in their regions. NADONA 2021
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Region 5
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https://www.phe.gov/Preparedness/planning/hpp/Pages/find-hc-coalition.aspx
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Lessons Learned cont. • If you maintain some drugs in house - Consider ordering comfort medications (liquid morphine, liquid lorazepam and atropine) when patients develop fever and/or respiratory symptoms and/or COVID+ test result. • ALF should consider immediate comfort care staff education on shortness of breath / respiratory distress at end of life and consider partnering with Hospice for an emergency Hospice support line for staff • AL Facilities should consider assessing the % of staff that have secondary positions at other nursing facilities as if there is an outbreak, their staffing may be reduced by this amount. • May need to trim down medication lists • If client is independent with med set up and administration add checking on it during daily rounds • Decreasing cross contamination of workers •
Depending on the number of clients it might be advisable to provide avenues of entry and exit to prevent cross contamination of workers Have an entry for workers coming from home, and a separate exit for workers leaving after shift.
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Lessons Learned cont. • Develop a spreadsheet to track all patients under suspicion for COVID. Minimum data would include: • • • • • • • • •
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Unit number/hospital Name Age Onset of symptoms/beginning of quarantine End of quarantine Date of testing Results of testing Code status, Hospitalization status Whether family has been contacted re. status and whether ACP discussion has been held • Date of deaths
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Lessons Learned cont. • Start Goals of Care conversations early. (Advance Directives) Talking points: • COVID can be lethal for elderly clients and for those with multiple diseases • Your facility has and will continue to offer a robust set of services for symptom management as well as palliative care • If a resident develops acute respiratory failure, experience and studies have shown that it is highly unlikely they will recover even with hospital transfer and ventilation • Transfer to the hospital will put a frail elder at further risk of trauma, exposure to diseases and interventions that will be unlikely to help. • Comfort care in a familiar setting by nurses, aids and doctors that know their history, personality and proclivities is the kindest, most humane way to ensure comfort and dignity at the end of life. • Ensure RESUSCITATION and TRANSFER PREFERNCE information is clearly marked / accessible for ALL HEALTHCARE WORKERS NADONA 2021
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Lessons learned cont. https://www.health.state.mn.us/diseases/coronavirus/hcp/mh.html
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Lessons learned cont.
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Lessons learned cont. https://www.health.state.mn.us/diseases/coronavirus/hcp/7things.pdf
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Lessons learned cont. https://www.health.state.mn.us/diseases/coronavirus/hcp/7things.pdf
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What’s The Plan For The Future?
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Planning for the Future • Do we have a plan? • Does the plan include the following areas: • Identification of the team members • Resource contacts ( Local, State trade organization contacts) • Resources used to develop the plan ( Evidence Based Standards) • Authorized personnel & Organizational structure when plan is implemented
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Planning for the Future cont. • Do we have a plan cont.? • Plan Details include: • • • • • • •
Surveillance & Detection plan Communication plan Education and Training plan Plan for managing clients and visitors during pandemic Occupational health plan for staff Vaccination and Antiviral plan Issues Regarding surge capacity
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Planning for the Future cont. • Do we have a plan cont.? • Does the plan include the following for scarce resources: • Core strategies to be employed (generally in order of preference) during, or in anticipation of a scarce resource situation are: • Prepare - pre-event actions taken to minimize resource scarcity (e.g., stockpiling of medications). • Substitute - use an essentially equivalent device, drug, or personnel for one that would usually be available (e.g., morphine for fentanyl). • Adapt – use a device, drug, or personnel that are not equivalent but that will provide sufficient care (e.g., anesthesia machine for mechanical ventilation). NADONA 2021
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Planning for the Future cont. • Do we have a plan cont.? • Conserve – use less of a resource by lowering dosage or changing utilization practices (e.g., minimizing use of oxygen driven nebulizers to conserve oxygen). • Re-use – re-use (after appropriate disinfection/sterilization) items that would normally be single-use items. • Re-allocate – restrict or prioritize use of resources to those patients with a better prognosis or greater need.
• Network into the Healthcare Coalitions • Stock up on PPE – – Tip get it all Hair, Feet coverings as well as the standard – Creep up your inventory and ordering numbers • (Work with vendors to increase your numbers) NADONA 2021
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Planning for the Future cont. – N95 Respirators • Be sure to have respirator procedures in place to use them’ • Fit testing • Training protocols
– Hand Sanitizers • Stock up • Be sure the alcohol level is between 60-95%
• Review your Emergency and Hazard Policies – Check that pandemics are included – Be sure that you have a Outbreak / Pandemic policy in your Infection Control Policies and Procedures Manual
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Future Challenges • Major Challenges & Opportunities we face: • Influenza Season • Staffing • Implementing Guidance and IPC Improvements • Masks • Hand Hygiene • Social Distancing • IP Role • Outbreak Testing
• Other Issues at Hand • • • • • •
Discussion of Advance Directives Communication Reporting Contract/Memorandums of Understanding (MOAs) with other providers Collaboration with other like providers Secondary Morgue arrangements
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COVID-19 Vaccines • Types available – Pfizer 2 Injections 4 weeks apart – Moderma 2 Injections 4 weeks apart – Johnson & Johnson 1 Injection
• Hospital, Nursing Home & ALF staff & Patients /Residents and Clients were vaccinated 1st • Barriers – Fear • Immediate Side Effects • Long Term effects
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Influenza • Who Should be Vaccinated? • CDC recommends: • 6 months and older • Especially important for anyone at high risk for serious complications of influenza • CDC does not recommend influenza vaccinations for those individuals who are suspected or confirmed (regardless of whether they have symptoms) to have COVID-19 • Should circle back to them when recovered or testing negative
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Influenza cont. • When to Vaccinate? • CDC recommends by the end of October • Vaccination in late summer (July /August) could result in lower protection against the flu later in the season (older adults) • Children who need 2 doses should start earlier as there needs to be 2 weeks between doses
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Influenza cont. • Influenza vaccinations during the Covid pandemic? • Yes to protect those at higher risk and reducing the burden of respiratory illnesses (this includes PPE, ICU beds, staffing)
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Influenza cont. • How to increase vaccination rates in the facility? • Implement policies requiring influenza vaccination • Influenza vaccination requirements work; they are the only intervention that have consistently raised influenza vaccination rates of the staff to near universal coverage (Hollmeyer H, Hayden F, Mounts A, Buchholz U. Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza Other Respir Viruses 2013; 7(4): 604-21. ) • Guidance for Implementing Influenza Vaccination Requirements for Healthcare Personnel in Long-Term Care Facilities 17 August 2018 (Version 2) Provides how a facility might implement this practice
• • • •
Education Free vaccinations Free vaccinations for family Vaccinations available at the facility
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Your Main Point Here
https://www.cdc.gov/flu/symptoms/c oldflu.htm
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Flu vs Covid-19 Symptoms Flu Symptoms
Covid-19 Symptoms
• Your Sub Points here Fever* or feeling feverish/chills
Fever or chills
Cough
Cough
Sore throat
Sore throat
Runny or stuffy nose
Congestion or runny nose
Muscle or body aches
Muscle or body aches
Headaches
Headache
Fatigue (tiredness)
Fatigue
Vomiting/Diarrhea (children more common)
Nausea or vomiting Diarrhea Shortness of breath or difficulty breathing
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New loss of taste or smell
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Staffing • Many facilities had to “borrow” staff from sister facilities • Many needed to call on the state staffing – Several concerns with this process • “No shows” • Many hours late • Fired employees were being used by state and not allowed in facility • Issues with staff not allowing testing and then being relieved of duty
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Staffing • Large turnovers have occurred • Survey • • • •
70% reported feeling “obliged to work when ill” 17% had second job Certified nurse assistants more often held second jobs (other facilities?) 60% served as unpaid caregivers to children and/or adult relative
• Look for retirees or previous employees that might be willing to work part time • Request assistance from trade organizations & State agencies CDC/NCHS National Study of LTC Providers; https://phinational.org/wp-content/uploads/legacy/phi-facts-3.pdf; http://www.homehealthaideguide.com/hhacareer/nursing-home/
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Implementing Guidance and ICP Improvements • Hand Hygiene • Prioritize the use of alcohol‐based hand sanitizer (ABHS) over soap and water unless hands are visibly soiled • ABHS should contain between 60‐95% alcohol • ABHS should be placed where resident‐care is provided: • Ideally both inside and outside of client units • Dining halls • Common Areas
•
HCP are more likely to perform hand hygiene if ABHS is easily accessible and part of their normal workflow
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Implementing Guidance and ICP Improvements cont. PPE • • • •
Significant increase in PPE utilization; need for fit‐testing if using N95 respirators PPE supply shortages and varying PPE types and brands Estimating supplies and planning for the future PPE Selection and use • Wearing multiple layers of PPE • Confusion about when to start/stop using crisis strategies such as extended use and re‐use and where to use them • Staff training and auditing on donning and doffing • Understand current inventory, supply chain, and PPE utilization rate • Communicate with local healthcare coalitions, public health partners • Provide HCP with education and training for any PPE being used
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Equipment
Continency Capacity
Crisis Capacity
N95 Respirators
-Temporarily suspend annual fit testing - Extend use of N95 respirator
-Use respirators approved under standards used in other counties -Practice limited re-use in addition to extended use
Facemasks
-Extend use of facemasks
Practice limited re-use in addition to extended use
Gowns
-Consider use of coveralls
Extend the use of isolation gowns -Prioritize gowns for activities with splashes/sprays and high-contact resident-care 67
https://www.cdc.gov/coronavirus/2019‐ncov/hcp/ppe‐strategy/strategies‐optimize‐ppe‐shortages.html
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Implementing Guidance and ICP Improvements cont. Crisis Capacity Gown use • Consider extending the use of isolation gowns (disposable or reusable): • Housed in same location • Known to be infected with same infectious disease • Can ONLY be considered when no other infectious diagnoses • Prioritize gowns for splashes/sprays and high‐touch care • Consider risks to HCP and resident safety with gown reuse: repeated donning and doffing may increase risk for HCP self‐contamination and contribute to spread of other pathogens (e.g., Candida Auris) • Do not use more than one isolation gown at a time • *As gown availability returns to normal, you must promptly resume conventional practices NADONA 2021
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PPE Utilization Burn Calculator
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https://www.cdc.gov/coronavirus/2019‐ ncov/hcp/ppe‐strategy/burn‐calculator.html
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Implementing Guidance and ICP Improvements cont. • Outbreak Testing • A single new case of SARS‐CoV‐2 infection in any HCP or a nursing‐home onset SARS‐CoV‐2 infection in a client should be considered an outbreak • Performing viral testing of all clients as soon as there is a new confirmed case in the facility will identify infected clients quickly • Rapid implementation of IPC interventions • Clinical management • Reporting mandates
• Prioritize a dedicated COVID‐19 care area
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Implementing Guidance and ICP Improvements cont. Infection Preventionist Assign one or more individuals with training in infection control to provide on‐site management of the IPC program – In New Jersey an order was written for ALFs to have a Nurse Preventionist – Potential for other states to require this in the future – Role should be assigned to Nurse or other clinical position – There are several online courses available to assist with additional education
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Other Challenges • Other Issues • Discussion of Advance Directives/care goals • Communication – • Clients / Staff / Families/Agencies
• Reporting • Incidences • Testing
• Contract/Memorandums of Understanding (MOAs) with other providers • Hospitals • Transport
• Collaboration with other like providers • Nursing Homes • Assisted Living
• Secondary Morgue arrangements • Collaboration with area funeral homes and hospitals NADONA 2021
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Training
https://www.cdc.gov/coronavirus/2019‐ncov
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Summary Key Take Aways • Do you have: • A Pandemic Plan • Essentials of the plan: • • • • •
PPE (MASKS) Hand Hygiene Staffing Social Distancing Testing
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Resources CDC COVID‐19 Resource Page – Infection Control Guidance – Testing guidance – Assessment tools – Training materials
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Resources • COVID-19: Considerations, Strategies, and Resources for Crisis Standards of Care in Post-Acute and Long-Term Care (PALTC) Facilities https://files.asprtracie.hhs.gov/documents/covid-19-considerations-strategies-andresources-for-crisis-standards-of-care-in-paltc-facilities.pdf • https://www.health.state.mn.us/communities/ep/surge/crisis/standards.pdf • https://www.cdc.gov/flu/pandemic-resources/pdf/longtermcare.pdf • https://cmda.us/resources/COVID%20Lessons%20from%20Battlefield%20Handout.pdf Jim Wright MD, Henrico, VA (4/5/2020) • https://www.health.state.mn.us/diseases/coronavirus/hcp/mh.html • https://www.health.state.mn.us/diseases/coronavirus/hcp/mhanxieties.pdf • https://www.health.state.mn.us/diseases/coronavirus/hcp/mhconcerns.pdf
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Resources https://www.health.state.mn.us/diseases/coronavirus/hcp/crisis.html https://www.health.state.mn.us/diseases/coronavirus/hcp/staffoptions.html https://www.health.state.mn.us/diseases/coronavirus/hcp/ltctoolkit.pdf https://www.health.state.mn.us/diseases/coronavirus/hcp/ltcipchohort.pdf https://www.health.state.mn.us/diseases/coronavirus/hcp/ltceoguide.html https://www.health.state.mn.us/diseases/coronavirus/hcp/ltcvisit.pdf https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalizedpatients.html https://www.health.state.mn.us/diseases/coronavirus/hcp/7things.pdf https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/strategiesoptimize-ppe-shortages.html https://www.health.state.mn.us/diseases/coronavirus/hcp/ltctestrec.pdf NADONA 2021
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Cindy Fronning cindy@nadona.org 651-324-8415
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Pandemic Flu Plan Outline I. Structure for planning & Decision making 1. Is referred to in the facility Emergency Preparedness Policy & Plan A. List name of policy/plan and section referred to. ________________________________ 2. Is a part of the emergency management planning and exercises for facility A. List where in emergency P&P where exercises are identified. ____________________ 3. Has a multidisciplinary planning committee or team to specifically address pandemic influenza or other disease preparedness planning A. List Teams name: ___________________________________________ B. Pandemic Influenza Response Coordinator: -------------------------------------------------------4. List the members of the planning committee include (as applicable to each setting) the following: (Develop a list of committee members with the name, title, and contact information for each personnel category checked below as appropriate) Facility administration Medical director Nursing administration Infection control Occupational health Staff training and orientation Engineering/maintenance services Environmental (housekeeping) services Dietary (food) services Pharmacy services Occupational/rehabilitation/physical therapy services Transportation services Purchasing agent Facility staff representative Other member(s) as appropriate (e.g., clergy, community representatives, department heads, resident and family representatives, risk managers, quality improvement, direct care staff, collective bargaining agreement union representatives) 5. Local & State Health Departments & Provider/trade organization points of contact for resources information A. Local health department contact: ______________________________________ B. State health department contact: ______________________________________ C. State long-term care professional/trade association: ___________________________________ 6. Local, regional, or state emergency preparedness groups, including bioterrorism/communicable disease coordinators points of contact have been identified. (Insert name, title and contact information for each.)
A. City: ____________________________________________________________________ B. County: __________________________________________________________________ C. Other regional: ____________________________________________________________ 7. Area hospitals points of contact have been identified in the event that facility residents require hospitalization or facility beds are needed for hospital patients being discharged in order to free up needed hospital beds. (Attach a list with the name, title, and contact information for each hospital) 8. Documentation attached reflecting that the Pandemic Influenza Response Coordinator has reached out to the local or regional pandemic influenza planning groups to obtain information on coordinating the facility’s plan with other influenza plans II. Resources Used to develop plan 1. Copies of the relevant sections of the HHS Pandemic Influenza Plan (https://www.cdc.gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf) and available state, regional, or local plans are attached and have been incorporated into this plan III. Authorized Personnel 1. Person(s) authorized to implement the plan: ____________________________________________ ______________________________________________________________________________ 2. Organizational structure that will be used when under the plan: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ IV. Plan Details 1. Surveillance and detection plan for the presence of pandemic influenza/disease in residents and staff A. The person who has been assigned responsibility for monitoring public health advisories (federal and state), and updating the pandemic response coordinator and members of the pandemic influenza planning committee when pandemic influenza has been reported in the United States and is nearing the geographic area is: ________________________________________________________________________ (name, title and contact information) (Ref: https://www.cdc.gov/flu/weekly/fluactivitysurv.htm) B. The following is our protocol for weekly or daily (pick one) monitoring of seasonal influenza-like illness in our residents and staff. (Using this system for tracking illness trends during seasonal influenza will ensure that the facility can detect stressors that may affect operating capacity, including staffing and supply needs, during a pandemic.) https://www.cdc.gov/flu/professionals/diagnosis/ 1. We will: _______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
______________________________________________________________________________ ______________________________________________________________________________ 2. See attachments 4-1, 4-2, 4-3, 4-4 for guidelines in testing. 3. See attachment 4-5 for our line listing of infections. (Add your line listing here.) C. Our protocol for evaluation and diagnosis of residents or staff with symptoms of pandemic influenza/disease is: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________ D. See attachment 4-6 for our screening form. E. An assessment for seasonal influenza is included in the evaluation of incoming residents. Attached (4-7) is our admission policy or protocol to determine the appropriate placement and isolation of patients with an influenza-like illness. (The process used during periods of seasonal influenza can be applied during pandemic influenza.) F. See attachment 4-8 for our system to monitor for, and internally review transmission of, influenza among patients and staff in the facility. Information from this monitoring system is used to implement prevention interventions (e.g., isolation, cohorting). 2. Our facility communication plan is as follows: A. Key public health points of contact during an influenza pandemic: 1. Local Health department contact (name, title and contact) _________________________________________________________________ __________ 2. State health department contact: (name, title and contact) _________________________________________________________________ __________ B. The following person has been assigned responsibility for communications with public health authorities during a pandemic. (Insert name, title and contact information.) ________________________________________________________________________ C. The following person has been assigned responsibility for communications with staff, residents, and their families regarding the status and impact of pandemic influenza in the facility. (We feel that having one voice that speaks for the facility during a pandemic will help ensure the delivery of timely and accurate information.) ________________________________________________________________________ D. We update our family member / guardian / resident lists on a weekly basis. see attachment 4-9 E. The following is our communication plan that includes how signs, phone trees, and other methods of communication that will be used to inform staff, family members,
visitors, and other persons coming into the facility (e.g., sales and delivery people) about the status of pandemic influenza in the facility. See attachment 4-10. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ F. Attached is a list that has been created of other healthcare entities and their points of contact (e.g., other long-term care and residential facilities, local hospitals’ emergency medical services, relevant community organizations [including those involved with disaster preparedness]) with whom it will be necessary to maintain communication during a pandemic. (Insert location of contact list and attach a copy to the pandemic plan.) See Attachment 4-11. G. The following facility representative(s) has been involved in the discussion of local plans for inter-facility communication during a pandemic 3. We have a plan in place to provide education and training to ensure that all personnel, residents, and family members of residents understand the implications of, and basic prevention and control measures for pandemic influenza. A. The following person has been designated with responsibility for coordinating education and training on pandemic influenza (e.g., identifies and facilitates access to available programs, maintains a record of personnel attendance). (Insert name, title, and contact information.) ____________________________________________ B. Current and potential opportunities for long-distance (e.g., web-based) and local (e.g., health department or hospital-sponsored) programs have been identified. See www.cdc.gov/flu/professionals/training/. See attachment 4-12. C. Language and reading-level appropriate materials have been identified to supplement and support education and training programs (e.g., available through state and federal public health agencies such as www.cdc.gov/flu/groups.htm and through professional organizations), and are available to the staff. See attachments 4-13 & 4-14. D. Our education and training includes information on infection control measures to prevent the spread of pandemic influenza. See attachment 4-15 for our educational topics /content and dates of training. E. Our plan for expediting the credentialing and training of non-facility staff brought in from other locations to provide patient care when the facility reaches a staffing crisis is as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ______________________________________________________
F. Informational materials (e.g., brochures, posters) on pandemic influenza and relevant policies (e.g., suspension of visitation, where to obtain facility or family member information) have been developed or identified for residents and their families. These materials are language and reading-level appropriate, and a plan is in place to disseminate these materials in advance of the actual pandemic. See the following for our plan of dissemination and location of materials: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ See attachment 4-16 for a list of materials. 4. We have an infection control plan in place for managing residents and visitors with pandemic influenza that includes the following: A. Our infection control policy requires that direct care staff use Standard and droplet Precautions with symptomatic residents. See Attachment 4-18 for the actual policy. B. We have implemented the following plan for Respiratory Hygiene/Cough Etiquette throughout the facility. See attachment 4-19. C. Our plan for cohorting resident symptomatic residents is as follows: 1) Confining symptomatic residents and their exposed roommates to their room, 2) Placing symptomatic residents together in one area of the facility, or 3) Closing units where symptomatic and asymptomatic residents reside (i.e., restricting all residents to an affected unit, regardless of symptoms). 4) Where possible, staff who are assigned to work on affected units will not work on other units. D. We have established criteria and protocols for closing units or the entire facility to new admissions when pandemic influenza is in the facility. See attachment 4-20. E. We have developed criteria and protocols for enforcing visitor limitations per federal and state guidelines. See attachment 4-21. 5. We have developed an occupational health plan for addressing staff absences and other related occupational issues that include the following: (See attachment 4-22) A. A liberal/non-punitive sick leave policy that addresses the needs of symptomatic personnel and facility staffing needs. The policy includes: 1. The handling of personnel who develop symptoms while at work. 2. When personnel may return to work after having pandemic influenza. 3.When personnel who are symptomatic, but well enough to work, will be permitted to continue working. 4. Personnel who need to care for family members who become ill B. We have created a plan to educate staff to self-assess and report symptoms of pandemic influenza before reporting for duty. See attachment 4-23. C. We have created a list of mental health and faith-based resources that will be available to provide counseling to personnel during a pandemic. See attachment 4-24. D. We have established a system to monitor influenza vaccination of personnel. See attachment 4-25.
E. A plan for managing personnel who are at increased risk for influenza complications (e.g., pregnant women, immunocompromised workers) by placing them on administrative leave or altering their work location. See attachment 4-26. 6. We have a vaccine and antiviral plan See attachment 4-27 A. Our plan includes both CDC and state websites for obtaining the most current recommendations and guidance for the use, availability, access, and distribution of vaccines and antiviral medications during a pandemic. (www.hhs.gov/pandemicflu/ plan/sup6.html and www.hhs.gov/pandemicflu/plan/sup7.html. B. We used the HHS guidance to estimate the number of personnel and residents who would be targeted as first and secondary priority for receipt of pandemic influenza vaccine or antiviral prophylaxis. C. We have constructed a plan for expediting delivery of influenza vaccine or antiviral prophylaxis to residents and staff as recommended by the state health department. 7. We have addressed the issues related to surge capacity during a pandemic in the following manner: (see attachment 4-28) A, A contingency staffing plan has been developed that identifies the minimum staffing needs and prioritizes critical and non-essential services based on residents’ health status, functional limitations, disabilities, and essential facility operations. B. A person has been assigned responsibility for conducting a daily assessment of staffing status and needs during an influenza pandemic. (Insert name, title and contact information.) ________________________________________________________________________ C. We consulted legal counsel and state health department contacts to determine the applicability of declaring a facility “staffing crisis” and appropriate emergency staffing alternatives, consistent with state law. D. Our staffing plan includes strategies for collaborating with local and regional planning and response groups to address widespread healthcare staffing shortages during a crisis E. Estimates have been made of the quantities of essential materials and equipment (e.g., masks, gloves, hand hygiene products, intravenous pumps) that would be needed during a six-week pandemic. F. A plan has been developed to address likely supply shortages, including strategies for using normal and alternative channels for procuring needed resources. G. Alternative care plans have been developed for facility residents who need acute care services when hospital beds become unavailable. H. Our surge capacity plans include strategies to help increase hospital bed capacity in the community. 1. Signed agreements have been established with area hospitals for admission to the long-term care facility of non-influenza patients to facilitate utilization of acute care resources for more seriously ill patients. 2. Facility space has been identified that could be adapted for use as expanded inpatient beds and information provided to local and regional planning contacts. I. We have developed a contingency plan for managing an increased need for post mortem care and disposition of deceased residents. J. We have identified an area in the facility that could be used as a temporary morgue. K. Local plans for expanding morgue capacity have been discussed with local and regional planning contacts. (https://www.cdc.gov/flu/pandemic-resources/pdf/longtermcare.pdf)
Additional Resources: Clinical Care in a Pandemic
Infection Prevention Training (FREE Infection Prevention Training from CDC. While the focus in on nursing homes, it is free education, and you can earn CEUs too) https://www.cdc.gov/longtermcare/training.html
2021 Housing & Nurse Managers' Education Series
LEGAL ISSUES FOR HOUSING & NURSE MANAGERS March 17, 2021
Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rob Rodè, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC
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INTRODUCTIONS Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rebecca K. Coffin is a partner with the law firm of Voigt, Rodè, Boxeth & Coffin, LLC practicing in health law, including accounts receivable, regulatory compliance, and HIPAA compliance. Ms. Coffin represents providers on nursing facility and home care licensing, including change of ownership and bed relocation transactions. Ms. Coffin also practices in employment law and advises clients on a variety of employment and labor issues. She currently represents a number of nursing facilities, home care agencies, and housing with services providers.
Rob Rodè, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Robert F. Rodè is a partner and practices in the areas of health law, civil litigation, employment law, administrative law, and construction law. Mr. Rodè has a special emphasis on long-term care providers, home health agencies, rehabilitative agencies, and housing with services providers. In practice, Mr. Rodè represents and advises clients on issues such as regulatory compliance; the long-term care survey and appeal process; behavior issues; resident discharge; contract negotiations and drafting; dispute resolution; housing; civil and administrative litigation; arbitration and mediation; employment; and accounts receivable.
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LEGAL ISSUES FOR HOUSING & NURSE MANAGERS 2021 Care Providers of Minnesota Housing & Nurse Managers’ Education Series
Robert F. Rodè, Esq.
Rebecca K. Coffin, Esq.
rrode@vrb-law.com
rcoffin@vrb-law.com
Voigt, Rodè, Boxeth & Coffin, LLC 1000 University Ave W, Suite 250 St. Paul, MN 55101 651-209-6161
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OBJECTIVES Learn applicable laws for HWS/AL and home care Know federal and state Fair Housing laws and how they affect you Understand consumer protection laws and how to avoid pitfalls Consider when it is appropriate to terminate a lease Understand POLST
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SUMMARY OF LAWS IMPACTING MN HWS/HOME CARE PROVIDERS Housing - Landlord • Landlord-Tenant law • Fair Housing Law – state and federal • Housing with Services law (through 7-31-21) • Assisted Living law (new 8-1-21) • Dementia disclosure and training laws • Consumer Protection laws
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SUMMARY OF LAWS IMPACTING MN HWS/HOME CARE PROVIDERS (CONTINUED) Home care-related: • MN Home Care law • Nurse Practice Act • Assisted Living law (8-1-21) • Dementia training/disclosure laws • Consumer Protection laws • Elderly Waiver and other services 6
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LANDLORD TENANT LAW Minnesota Chapter 504B Applies to “independent” senior housing and housing with services Defines when a lease is required Mandatory lease provisions Duties of landlord & tenant
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MINNESOTA STATUTES § 504B BRIEF OVERVIEW Written Lease Deposits/Fee Interest Tenant’s Right to Privacy Termination and Notice Provisions Recovery of landlord’s attorney fees Abandoned property Eviction
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HOME CARE – APPLICABLE LAWS Nurse Practice Act – Minn. Stat. § 148.171 to 148.285 Home Care Law - Minn. Stat. Ch. 144A Assisted Living law - Minn. Stat. Ch. 144G
◦ AL rules are pending – in Administrative Law Judge’s hands
Dementia training and disclosures
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HOME CARE – APPLICABLE LAWS (CONTINUED) Consumer Protection laws (more on this later) Elderly Waiver
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APPLICABLE NONDISCRIMINATION LAWS
504 of the Rehabilitation Act
Fair Housing Amendments Act
Americans with Disabilities Act
Minnesota Human Rights Act
Local Ordinances
HUD Contract Requirements You may be able to “discriminate” against predatory offenders depending on facts
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FAIR HOUSING BASICS WHAT IS IT? It offers protections for tenants when they are: • Renting • Buying • Securing financing for any housing
Applies to “dwellings,” including: • Senior apartments • Housing with Services • Memory Care • Assisted Living • Ownership town homes, condominiums, and cooperatives
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FAIR HOUSING BASICS- TO WHOM DO THE LAWS APPLY?
Everyone involved with selling or renting real estate • More specifically, as applicable with HWS/AL: •
• Landlords • Property Managers • Owners
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FAIR HOUSING Fair Housing applies to: Housing with Services/Assisted Living Senior Housing Memory Care
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PROTECTED CLASSES UNDER FAIR HOUSING LAWS • • • • • •
Race Family Status (having kids or being pregnant) Disability Sex (including sexual harassment) Public Assistance National Origin
•Color •Sexual Preference •Age (St. Paul) •Religion •Marital Status (being single or divorced) •Creed (beliefs)
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FAIR HOUSING SENIOR HOUSING
Housing for Seniors ◦ Must rent to families with children unless considered “housing for older persons” 80% of units must be occupied by at least one person 55 or older; Units occupied solely by persons 62 and older; or Housing provided under special federal and state funding programs
Advertising Handicap discrimination
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WHO WILL ACCUSE THE PROVIDER OF DISCRIMINATION? Enforcement Mechanisms: Family - Informal resolution with housing provider
Public housing authority grievance procedure
Minnesota Housing Finance Agency
HUD
Local civil rights agencies/commissions
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FAIR HOUSING ADVERTISING
Advertising
◦ Not required to use the Fair Housing logos o Generally prohibited against making, printing or publishing, any notice, statement or advertisement that indicates any preference, discrimination or limitation because of race, color, national origin, religion, sex, familial status, or handicap
Fair Housing Poster:
◦ Must have a Fair Housing poster displayed prominently in the facility
Handicap discrimination
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ADDITIONAL PROTECTION- DISABILITY/HANDICAP •
Individuals with: • A physical or mental impairment • • • • • • •
Hearing Mobility and visual impairments Chronic alcoholism Chronic mental illness AIDS AIDS related complex Mental Impairment
• A record of a disability • Regarded as having a disability
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FAIR HOUSING HANDICAP DISCRIMINATION
Cannot discriminate on basis of handicap ◦ Prospective tenants ◦ Current tenants ◦ Any person associated with tenant What is a “handicap”?
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FAIR HOUSING ACT HANDICAP DEFINED Under the Act, “handicap” means: with respect to a person, or mental impairment which substantially limits one or more major life activities a record of such an impairment; or being regarded as having such an impairment.
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FAIR HOUSING HANDICAP DISCRIMINATION PROHIBITED Unlawful to discriminate against any person in the terms, conditions, or privileges of the rental of a dwelling, or in the provision of services or facilities in connection with such dwelling, because of handicap. NO INQUIRY RULE: Unlawful to inquire to determine whether an applicant for a dwelling (or a person intending to reside in that dwelling after it is sold, rented, or made available or any person associated with that person) has a handicap. Unlawful to inquire as to the nature or severity of a handicap of an applicant, potential tenant or associated person.
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FAIR HOUSING HANDICAP DISCRIMINATION: PERMITTED INQUIRIES
Can make inquiries to determine if the applicant: • Can meet the requirements of tenancy – but those requirements must be non-discriminatory • Is a current illegal abuser or addict of a controlled substance • Has been convicted of the illegal manufacture or distribution of a controlled substance • Qualifies for a dwelling legally available only to persons with a disability or to persons with a particular type of disability • Qualifies for housing that is legally available on a priority basis to persons with disabilities or to persons with a particular disability
24 C.F.R. § 100.202
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FAIR HOUSING HANDICAP DISCRIMINATION EXCEPTION A Dwelling Need Not Be Made Available: To an individual with a handicap who is a direct threat to the health or safety of other individuals; or To an individual with a handicap whose tenancy would result in substantial physical damage to the property of others. Individual with a handicap listed in Fair Housing Act not “safe”? No exception. 24 C.F.R. 100.202(d)
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FAIR HOUSING REASONABLE ACCOMMODATION •
Change, exception, or adjustment to a rule, policy, practice or service that may be necessary for a person with a disability to have an equal opportunity to use and enjoy a dwelling, including public and common use spaces.
•
Examples: • Service/companion animals in “no pet” building • Reserved parking space • Allow live-in aid
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FAIR HOUSING REASONABLE MODIFICATION It is unlawful for any person to refuse to permit, at the expense of the handicapped person, reasonable modifications of existing premises occupied or intended to be occupied by such person if such modifications may be necessary to afford such person full enjoyment of the premises of a dwelling. A “modification” means any change to the public or common use areas of a building or any change to a dwelling unit.
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LIMITS TO REASONABLE ACCOMMODATIONS AND MODIFICATIONS Can deny if the request was not made by or on behalf of a person with a disability; or • If there is no disability-related need for the accommodation •
•
Can be denied if providing the accommodation is not reasonable • It would impose an undue financial and administrative burden on the housing provider or alter the nature of the provider’s operation
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FAIR HOUSING LAWS More issues Examples
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WHAT ADVERTISING LAWS APPLY TO YOU? Consumer Breach
Protection Laws
of Contract
Federal
and State Fair Housing Acts (Non-Discrimination Laws)
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CONSUMER PROTECTION LAWS ◦ ◦ ◦ ◦
Deceptive Trade Practices Act State & Federal False Advertising Act Minnesota Consumer Fraud Act Deceptive Acts against a Senior Citizen or Disabled Person $10,000 penalty if violate Consumer Protection Laws and actions are against a senior citizen or disabled person.
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DECEPTIVE TRADE PRACTICES ACT MINN. STAT. §§ 325D.43–325D.48
◦ A representation that goods or services have characteristics or benefits they do not have; ◦ Includes representing that goods and services are of a particular standard, quality or grade if they are of another 31
STATE AND FEDERAL FALSE ADVERTISING Minn. Stat. §
325F.67
◦ Prohibits the use of untrue, deceptive or misleading statements in advertisements made available to the public with the intent to sell merchandise or services. Federal: 15
U.S.C. §§ 41―58
◦ Misrepresent the nature, quality or characteristics of the goods or services 32
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FALSE ADVERTISING
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MINNESOTA CONSUMER FRAUD ACT MINN. STAT. §§ 325F.68―325F.70
• Prohibits use of fraud or misrepresentation with the intent that others rely thereon in connection with the sale of merchandise. “Merchandise” includes services. • Frequently claim misrepresentation regarding the services provided (especially in IL v. AL realm), even when the person enters as an “independent resident.” o
Plaintiff not required to have actually been misled, deceived or damaged.
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EXAMPLES OF FALSE STATEMENTS ◦ Statements About Standard or Quality of Care: Best care,” “highest quality,” “state of the art,” and “maximum degree of independence” may give rise to a breach of an express or implied warranty. Words such as “quality,” “professional,” “superior” and “pre-eminent” are frequently cited in plaintiffs’ claims and litigation.
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QUALITY OF CARE FALSE STATEMENTS Statements
such as facility provides services “as required by law” or “quality standards above government regulations” led to Consumer Fraud, Deceptive Trade, and False Advertising Claims.
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EXAMPLES OF FALSE STATEMENTS
Assisted Living v. Housing with Services: ◦ Be Careful! ◦ Plaintiffs’ attorneys frequently claim misrepresentation regarding the services provided (especially in HWS v. AL realm), even when the person enters the community as an “independent resident.” o Typical consumer does not understand that Assisted Living and HWS provide different services and are subject to separate regulations. ◦ New AL law (8-1-21) prohibits advertising as an AL if you are not one
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DECEPTIVE ACTS AGAINST A SENIOR CITIZEN OR DISABLED PERSON MINN. STAT. §325F.71
◦ $10,000 additional penalty for violation of: Minn. Stat. §§ 325D.43–.48 (Deceptive Trade Practices) Minn. Stat. § 325F.67 (False Advertising) Minn. Stat. §§ 325F.68–.70 (Consumer Fraud) 38
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MARKETING MATERIALS ARE ONGOING
At move-in, “marketing” may end, but the risk of liability from marketing does not
The marketing may be misinterpreted by various audiences (e.g., family, ombudsman, MDH, AG) ◦ Just because you think your service scope is clear does not mean others do. ◦ All interested persons can bring an action. ◦ Other considerations: who’s got an axe to grind, is this an election year, disgruntled employees, etc.
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SERVICES ADVERTISED
Housing and home care providers must be upfront about services offered: • No false or misleading statements • Prospective tenant has right to know limits on services • New AL law requires list of services- be specific
“Home care providers shall not use false, fraudulent, or misleading advertising in the marketing of services. For purposes of this section, advertising includes any verbal, written, or electronic means of communicating to potential clients about the availability, nature, or terms of home care services.” Minn. Stat. § 144A.479(2) 40
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MARKETING MATERIALS ARE ONGOING Every contact by every staff person is “marketing”
What is promised vs. what is delivered ◦ Do they match? ◦ Broadly define services in marketing. What you say may not be what the various audiences hear.
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LEGAL ACTION BASED ON MARKETING IS POSSIBLE
Real life example: Risk of marketing as “memory care” but unable to provide ongoing service. AG brings suit alleging these legal causes of action: ◦ Deceptive Trade Practices (MN Stat. §325D.44): Represents services of one kind when they are another ◦ False Advertising (MN Stat. §325F.67): Materials untrue, deceptive or misleading ◦ Consumer Fraud (MN Stat. §325F.69): False promise, misleading representation, whether or not the person was misled
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LEGAL ACTION BASED ON MARKETING IS POSSIBLE (CONTINUED)
Real life example; AG brings suit alleging these legal causes of action: ◦ Deceptive Acts Perpetrated against Senior Citizens and Handicapped Persons (MS §325F.71): ◦ False advertising additional $10,000.00 fines if seniors or handicapped persons involved ◦ Medicaid Fraud (MS §256B.121): False representation and EW, then treble damages ◦ Patient Bill of Rights MS §144.651): Makes any interested person, including the AG able to bring an action
Best defense is a good offense – know what you are offering, deliver it and document it for proof.
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CASE EXAMPLE OF CONSUMER FRAUD Alleged representations: Facility would: ◦ Accept husband if it believed it could provide appropriate services, ◦ Provide emergency assistance and ◦ Provide notice within 12 hours of potential emergencies Claims: ◦ Negligence ◦ Violation of Minnesota Consumer Fraud Act ◦ Violation of Deceptive Acts Against Senior Citizens
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MAARC REPORTING
Under MN Vulnerable Adult Act, Minn. Stat. Sec. 626.557, report immediately, within 24 hours: ◦ Abuse ◦ Neglect ◦ Financial exploitation
Note nursing facilities must still report to OHFC (and abuse must be reported within 2 hours)
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LEASE TERMINATION
MN Landlord Tenant Laws ◦ MN Statutes 504B
Separate from home care agreement for home care services ◦ ONLY until 7-31-21
Also note current MN Executive Orders prohibiting evictions except for certain reasons due to COVID-19 46
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EVICTION ACTIONS - WHY EVICT? Non-payment Violation of the terms of the Lease
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TERMINATE THE LEASE?
Violation of the terms of the Lease
Examples:
Illegal drugs Smoking in non-smoking community Destruction of Landlord’s Property Behavior issues…
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AL EVICTIONS UNDER NEW LAW One termination for assisted living contract (not separate home care and housing)
Contract must include:
◦ “A delineation of the grounds under which the resident may be discharged, evicted, or transferred or have services terminated“
Minnesota Statutes § 144G.52, Subd. 2 ❖ Required
meeting with Resident BEFORE proceeding with terminating
❖Facility must meet with resident, resident’s legal representative and designated representative to: ❖ Explain the reasons for proposed termination; and ❖ Offer reasonable alternatives to avoid termination
❖ Must
be at least 7 days before Notice of Termination
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AL EVICTIONS UNDER NEW LAW Expedited termination if: resident substantially interferes with rights health or safety of other residents, staff, or certain criminal actions Expedited termination of services if conduct substantially interferes with resident’s safety or health; if needs exceed scope and services agreed upon Appeal Process Different (ALJ hearing)
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HE’S NOT SAFE…OR HE’S DANGEROUS
Crisis management Eviction planning Other tenants/clients/staff at risk Too complex for home care services provided Uncooperative client/family
Toughest issue to convince family/client/tenant of their increased needs Set expectations early and remind family/client/tenant 51
BE PROACTIVE Have a flexible housing agreement -BROAD Have a clear services agreement Discuss the service level issues upfront Set expectations early and remind often Know about mandatory consultation law and how it impacts dementia clients – who can help them Network with other service providers
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MOTORIZED SCOOTERS
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MOTORIZED SCOOTERS The NASCAR Granny Audit rules related to use of motorized carts to determine possible discriminatory impact
◦ Evaluate ability to reasonably accommodate ◦ Develop policies and procedures based on objective criteria ◦ Base any use restrictions on existence of direct threat to tenant safety
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MOTORIZED SCOOTERS
When setting policy, residential communities may not deny use of motorized carts (scooters), but may create a policy for times and routes of use. As an example, in US v. Hillhaven Corporation the community had established policies prohibiting scooters in crowded lobby areas around mealtimes due to safety concerns. The facility went further to set routes to enter the dining room and required placement near exits. When some of the scooter owners challenged this rule, the court upheld that the reasoning was acceptable to protect overall resident safety and that the policy did not discourage residency for persons who needed a motorized cart.
Additionally, facilities should not include testing for scooter driving and use skills competency as a condition of tenancy. Though the ADA rule allows some of this type of testing, FHA does not. The Department of Housing and Urban Development, as well as the Department of Justice may consider testing prior to occupancy to be discriminatory.
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ANIMALS
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OTHER CONSIDERATIONS
Animals ◦ ◦ ◦ ◦
Pets Service Animals Companion Animals Comfort Animals What do you mean? The dog who has been scaring other residents and who bit a staff member yesterday now has a “certificate” and we will be discriminating if we force a goodbye?
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PROVIDER’S ORDER FOR LIFE SUSTAINING TREATMENT (POLST) What is it? How does it work? Who signs it? Is it the same as an advance directive?
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LAST BUT NOT LEAST… NEW AND NEW(ISH) LEGISLATION Electronic Surveillance (1-1-20) Assisted Living Law (8-1-21)
◦ Licensed Assisted Living Directors
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QUESTIONS?
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LEGAL ISSUES FOR HOUSING & NURSE MANAGERS 2021 Care Providers of Minnesota Housing & Nurse Managers’ Education Series
Robert F. Rodè, Esq.
Rebecca K. Coffin, Esq.
rrode@vrb-law.com
rcoffin@vrb-law.com
Voigt, Rodè, Boxeth & Coffin, LLC 1000 University Ave W, Suite 250 St. Paul, MN 55101 651-209-6161
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2021 Housing & Nurse Managers' Education Series
ADDRESSING CONCERNS & COMPLAINTS: WHEN, HOW, & WHY? March 24, 2021
April J. Boxeth, JD, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC
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INTRODUCTIONS April J. Boxeth, JD, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC April J. Boxeth is of counsel at Voigt, Rodè, Boxeth & Coffin, LLC. Ms. Boxeth practices in the areas of health law, assisted living, long term care, senior housing, home care, hospice and adult day. Ms. Boxeth advises clients in the areas of regulatory compliance, behavior issues, guardian/conservator issues, probate law, accounts receivable, and general corporate matters and is a frequent presenter on all of these topics. Ms. Boxeth has worked in health law for more than 25 years; she is a former adjunct professor of the Business Law Practicum at William Mitchell College of Law and currently serves as faculty at the University of MN in the HSM/Long Term Care Management and Law course.
Rebecca Coffin, Esq, Attorney/Partner Voigt, Rodè, Boxeth & Coffin, LLC Rebecca K. Coffin is a partner with the law firm of Voigt, Rodè, Boxeth & Coffin, LLC practicing in health law, including accounts receivable, regulatory compliance, and HIPAA compliance. Ms. Coffin represents providers on nursing facility and home care licensing, including change of ownership and bed relocation transactions. Ms. Coffin also practices in employment law and advises clients on a variety of employment and labor issues. She currently represents a number of nursing facilities, home care agencies, and housing with services providers.
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2021 Housing & Nurse Managers' Education Series
ADDRESSING CONCERNS & COMPLAINTS: WHEN, HOW, & WHY? CARE PROVIDERS OF MINNESOTA 2021 HOUSING & NURSE MANAGERS’ EDUCATION SERIES
April J. Boxeth
aboxeth@vrb-law.com
Rebecca Coffin
rcoffin@vrb-law.com
Voigt, Rodè, Boxeth & Coffin, LLC 651-209-6161
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Objectives today: 1. Review best practices for family involvement in care and services; 2. Learn proactive legal and ethical action to avoid lawsuits by families when a bad event occurs; and 3. Understand the importance of the role of family and consumer in providing excellent service and supporting your good reputation
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2021 Housing & Nurse Managers' Education Series
Why address ? There are new challenges… Laws and expectations for AL and Home Care Providers changing and growing… State (and Federal) focus on abuse and neglect (DOJ); Increased IJs active legislation this session: AL licensing, discharge, Staffing issues: supervision issues Financial issues, ownership issues EW reimbursement rates in AL/Home Care Dementia care increasing – increases risks of allowing to age in place
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Think about stepping into New Opportunities… Abuse prevention is what you do – however, bad things happen Protection and safety of residents are the most important part of your job – keeping seniors safe Customer service is critical for PR and confidence in your services – YOU WANT TO HEAR families You wish to promote good faith reporting to stop any ongoing maltreatment You want to prohibit poor employees from working with you and your residents
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2021 Housing & Nurse Managers' Education Series
RESIDENT/FAMILY/SERVICE PROVIDERS SAME GOALS: It is the law and staff must be trained on VA – Family expectations and more vocal residents Is it abuse or neglect? F689 Accidents and supervision are #1 cited for SNF – regulatory system response Home care common deficiencies include contents of service plan Is it a crime? 24 hour reporting for theft (no serious bodily injury) but 2 hour reporting to law enforcement if serious bodily injury Are you a mandated reporter? Is the individual a vulnerable adult? In AL?
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RESIDENT/FAMILY/SERVICE PROVIDERS SAME GOALS: Review the law and your VA policies EVERY TIME Make your own conclusions: It WAS an accident Document and retain if you decide NOT to report Inform staff reporter whether you reported and if not, why not
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2021 Housing & Nurse Managers' Education Series
SET NEW EXPECTATIONS OF STAFF Name badges not enough – introduce over and over and over Know the client/resident and personal interests of them and their family Report: “Here is what I’ve done for you lately.” Easier to pre-report than post-report Listen after report
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Complaints: Listen and Respond Look at CMS All Cause Harm Prevention App A for ideas and use for training staff (document for surveyor review) Policies and procedures – update when regs change In-house strategy for handling complaints - written - from residents and clients - from family – The power of an apology – New CO LAW Colorado” (2019) - from staff – must investigate Difference between a grievance and a VA issue Staff hiring, retention program and education ongoing Personal contact critical – supervision and audits
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“Candor in
2021 Housing & Nurse Managers' Education Series
LISTENING TIPS Active listening: completely focused, not thinking about your response. Let them VENT. Reflective listening: restate back what the family told you. Clarify if necessary, what you heard. 1.
Be present, attentive and focused
2.
Approach conversation as a collaborative experience
3.
Refrain from trying to figure things out while family is speaking
4.
Don’t take things personally
5.
Let go of attachments, agendas or outcome
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Investigation is KEY…So you know what to say to family: Report to RN/Administrator/ED IMMEDIATELY No choice – Investigate/Evaluate/CONCLUDE Send employees home during investigation Talk to all persons involved Confidential and use two people Document all – statements, and YOUR conclusions Report back to staff and family (example: sex between residents) Adhere to corporate compliance plan
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2021 Housing & Nurse Managers' Education Series
VA Reporting – Does it Impact Me and should I tell the family? No services? Just Housing? No impact. Policy? Service Provider? Yes. License impacted? YOURS.
With new AL License VA reporting required Written request and conferences from licensing board Separate responsibility (Mitigating factors) if employee is the perpetrator Possible criminal charges and prosecution Reputation of your facility Let family know what is going on… before, during and after
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Questions and Case Scenarios Resident/Tenant refusing to eat or take medications Family unresponsive and unaggressive physician Dignity based upon resident’s complaints Nephew stealing money from incapacitated resident Hoarders Cameras placed by families Drug diversion – Bill of Rights citation – strict liability QUESTIONS? YOUR CASE SCENARIO?
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2021 Housing & Nurse Managers' Education Series
ADDRESSING CONCERNS & COMPLAINTS: WHEN, HOW, & WHY? CARE PROVIDERS OF MINNESOTA 2021 HOUSING & NURSE MANAGERS’ EDUCATION SERIES
April J. Boxeth
aboxeth@vrb-law.com
Rebecca Coffin
rcoffin@vrb-law.com
Voigt, Rodè, Boxeth & Coffin, LLC 651-209-6161
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2021 Nurse Managers' Education Series
DEALING WITH DIFFICULT BEHAVIORS March 25, 2021
James F. Adams, MSN, RN, PMHCNS-BC
Mental Health Therapy Provider – Encounter Telehealth Director, Psychiatric Mental Health Nurse Practitioner Program & Assistant Professor – Azusa Pacific University
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INTRODUCTIONS James F. Adams, MSN, RN, PMHCNS-BC
Mental Health Therapy Provider – Encounter Telehealth Director, Psychiatric Mental Health Nurse Practitioner Program & Assistant Professor – Azusa Pacific University James F. Adams is a Mental Health Therapy Provider with Encounter Telehealth and the Director of the Psychiatric Mental Health Nurse Practitioner Program at Azusa Pacific University. He has taught in the accelerated Master of Science in Nursing program (ELM) and in other School of Nursing graduate programs for the last seven years. James has also developed many clinical facility affiliation agreements, instituted a recovery model curriculum, as well as completed the revision of the program in 2014 to meet the new educational standards for Psych NP certification. James has extensive experience in geriatric psychology and provides care to residents in senior living communities safely and securely through telehealth. He is dedicated to delivering mental health services to residents in under-served communities, improving their wellness and quality of life. He believes that the most critical factors in becoming an effective provider are to promote hope to individuals and families with mental illnesses, to instill self-responsibility and empowerment, and in helping individuals living with mental illness seek a meaningful role in life.
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2021 Nurse Managers' Education Series
Dealing with Difficult Behaviors
Care Providers of Minnesota Nurse Managers Education Series
Presented by: James F. Adams, MSN, RN, PMHCNS-BC Provider at Encounter Telehealth, LLC Director, Psychiatric Mental Health Nurse Practitioner Program at Azusa Pacific University
March 25, 2021
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Agenda
We all have our moments; however, what are your options when a client’s behavior creates concern in staff and other residents? In this session we will discuss: • Common difficult behaviors in older adults • Why difficult behaviors occur • Assessments and behavior triggers • Behavior management • Intervention strategies
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2021 Nurse Managers' Education Series
Common Difficult Behaviors • Swearing, offensive language, inappropriate comments • Physical altercations with staff or other residents • Refusal to maintain personal hygiene • Paranoia, delusions, and/or hallucinations • Demanding special or undivided attention • Sexual behaviors • Wandering • Sleep Disruption
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Why Difficult Behaviors Occur
• Depression • Anxiety • Loneliness - 40% of women over 65 y/o have lost a spouse; 13% of men. • Stress • Chronic Mental Illness (Bipolar Disorder, PTSD, Schizophrenia, etc.) • Alzheimer’s Disease, Dementia, or Cognitive Decline • Physical Concerns (i.e., Delirium could point to a UTI in older adults) • Communication: Some experts suggest that difficult behaviors are forms of communication • COVID-19 Longhaulers
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2021 Nurse Managers' Education Series
Assessments and Behavior Triggers • Has the resident been diagnosed with a mental illness? • Has the resident recently changed medications or dosage? • Has the resident recently gone through any big life changes? (New to the facility, recently lost a loved one, recent hospitalizations, etc.) • Is the resident experiencing any physical symptoms or changes? • Has the resident recently received at least one of the following screenings? • Geriatric Depression Scale (GDS) • General Anxiety Disorder 7 (GAD-7) •
Brief Interview for Mental Status (BIMS)
• Montreal Cognitive Assessment or Mini-Cog
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Behavior Management
• ALL BEHAVIOR HAS MEANING – the story of the arresting officer • Communication is Key – provide consistent empathetic approach that focuses on symptom improvement • Make the resident a part of the process if possible- Give them a level of control and responsibility by offering choices • Recognize when the resident does not have full control over their words or actions • Focus on the positive, let go of the negative, and practice self-compassion • Psychotherapy/Counseling • Medication Management • Hospitalizations are a last resort
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2021 Nurse Managers' Education Series
Intervention Strategies
• To reduce anxiety: - multi-sensory mindfulness - cognitive behavioral therapy - distraction - remove the pt. from overstimulating environment - find out what soothes the patient (music, graft/art activity, go outside, family) Public disrobing or touching of the genitals may not be due to sexual urges but instead reflect underlying delirium, dementia, motor restlessness caused by akathisia. - Previous history of sexual activity predicts current behaviors; an overactive libido/sexual aggressiveness may decrease with use of SSRI’s. - Do not reinforce off-color or sexually inappropriate jokes
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Con’t
• Possible non-pharmacological approaches: – Reduce environmental clutter and noise – Remove items that could be thrown or that upset patient – Optimize lighting and give cues to heighten orientation – Provide eyeglasses, hearing aids, mobility support, etc. – Consider approaches based on patient history/preferences: hand massage, pet therapy, music listening – Caregiver education: reflective practice, skills targeting behavioral challenges, and enhancing coping techniques
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2021 Nurse Managers' Education Series
BEER’s CRITERIA – Medications to avoid in the elderly
• Antipsychotics, first (conventional) and second (atypical) generation: - Increased risk of cerebrovascular accident (stroke) and greater rate of cognitive decline and mortality in persons with dementia. - Avoid antipsychotics for behavioral problems of dementia or delirium unless non-pharmacological options (eg, behavioral interventions) have failed or are not possible and the older adult is threatening substantial harm to self or others. - Avoid, except in schizophrenia or bipolar disorder.
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BEER’s CRITERIA – Con’t
• Benzodiazepines • Short and intermediate acting: - Alprazolam ( Xanax), Estazolam, Lorazepam (Ativan), Oxazepam, Temazepam, Triazolam; also the hypnotics like Zolpidem (Ambien). • Long acting: - Chlordiazepoxide (alone or in combination with amitriptyline or clidinium), Clonazepam (Klonopin), Clorazepate, Diazepam (Valium), Flurazepam (Dalmae), Quazepam. • Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long acting agents; in general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults. • May be appropriate for seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, and periprocedural anesthesia.
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2021 Nurse Managers' Education Series
Differential for Delirium versus Dementia
• Delirium – sudden onset (days)
Dementia – chronic & progressive onset (months/years)
• Global memory changes
Recent memory degradation
• Alteration in attention
Attention preserved
• Altered level of consciousness
No changes in level of consciousness
• Cognitive changes that increase
Slow progression of cognitive changes
and decrease in severity over days
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Thank You for Your Time
• Questions? • Discussion
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Care Providers of Minnesota: Nurse Managers Education Series 'Dealing with Difficult Behaviors' Presented By: James F. Adams, MSN, RN, PMHCNS-BC
We all have our moments; however, what are your options when a client's behavior creates concern in staff and other residents?
Common Difficult Behaviors Swearing, offensive language, inappropriate comments Physical altercations with staff or other residents Refusal to maintain personal hygiene Paranoia, delusions, and/or hallucinations Demanding special or undivided attention Sexual behaviors Wandering Sleep Disruption
Why Difficult Behaviors Occur Depression Anxiety Loneliness Chronic Mental Illness (Bipolar Disorder, PTSD, Schizophrenia, etc.) Changes in medications or dosage Alzheimer's Disease, dementia, or cognitive decline Physical concerns or changes Recent big life changes (New to the facility, lost a loved one, recent hospitalizations, etc.) Communication: Some experts suggest that difficult behaviors are forms of communication
Behavior Management Communication is Key Make the resident a part of the process if possible Recognize when the resident does not have full control over their words or actions Focus on the positive, let go of the negative, and practice self-compassion Mental Health Therapy Medication Management
2021 Housing & Nurse Managers' Education Series
LEADERSHIP BEYOND COVID-19: IGNITE THE PASSION WITHIN March 31, 2021
Lisa Thomson, BA, LNHA, HSE, Chief Strategy and Marketing Officer Pathway Health
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INTRODUCTIONS Lisa Thomson, BA, LNHA, HSE, Chief Strategy and Marketing Officer Pathway Health Lisa Thomson is the chief strategy and marketing officer at Pathway Health Services. She has over 30 years of experience in the post-acute and long-term care arena, as well as other healthcare settings. Lisa is a sought-after national thought leader in the healthcare arena. She presents to a wide variety of healthcare and other business provider types and is a known keynote and international speaker. She has written numerous articles and has been published in national communications across the healthcare provider continuum. She has been voted as a “Top Female Healthcare Executive” and serves as a mentor for healthcare leaders across the nation.
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2021 Housing & Nurse Managers' Education Series
LEADERSHIP BEYOND COVID-19: IGNITE THE PASSION WITHIN Lisa Thomson Chief Strategy and Marketing Officer www.pathwayhealth.com
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Objectives ◦ Describe three key concepts for leading in today’s health care world ◦ Learn a group activity that will foster creativity and collaboration in a regulated world ◦ Identify how to develop a team that values each others' strengths and to improve professional development
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2021 Housing & Nurse Managers' Education Series
Rapid Pace
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Landscape of Change COVID-19 Evolution
MN Assisted Living Regulations, Administrator/Director License and Education Requirements
New Regulations/Guidance, Clinical Priorities, Oversight and Enforcement
State of Emergency, Changing Guidance for AL and Housing New Health Care Platforms, Communication, and More
Re-Opening Visitation Resurgence
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2021 Housing & Nurse Managers' Education Series
Recruiting
Customer Perception
Refereeing
Occupancy Survey Activity Reporting Outcomes
Staying Informed
Infection Control Priority
Training Budgeting
Modeling Coaching
Shut Down Admission or Move Ins
Monitoring Reporting Evaluating
New Licensure Requirements
Customer Expectations
PPE Shortages, Inventory
COVID - New Regulations and Guiidance
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2021 Housing & Nurse Managers' Education Series
Consulting | Talent | Training | Resources
This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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Consulting | Talent | Training | Resources
This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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2021 Housing & Nurse Managers' Education Series
Consulting | Talent | Training | Resources
Why healthcare? This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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Consulting | Talent | Training | Resources
This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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2021 Housing & Nurse Managers' Education Series
EMERGING TRENDS
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Shift: Care Settings & Acuity
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2021 Housing & Nurse Managers' Education Series
Clinical Priorities
Staff Education and Competency
New Expectations New Requirements ALDL
Care Coordination Partnerships
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COVID Fatigue
Redesign
Workforce
Increased Acuity
Shortages
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2021 Housing & Nurse Managers' Education Series
Consumerism
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Technology
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2021 Housing & Nurse Managers' Education Series
Health Care Preparedness
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IGNITE Disrupting Status Quo
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2021 Housing & Nurse Managers' Education Series
Crisis Leadership Model
https://www.ccl.org/wpcontent/uploads/2020/12/l eading-in-crisis-strategicpivot-center-for-creativeleadership.pdf
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Pivot to Leap Ahead
https://www.ccl.org/wpcontent/uploads/2020/12/l eading-in-crisis-strategicpivot-center-for-creativeleadership.pdf
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2021 Housing & Nurse Managers' Education Series
New Normal…
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Core Leadership Skills Communicate vision and goals Listen Build Relationships Trust Include Others Be a leader – Not a boss
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2021 Housing & Nurse Managers' Education Series
Myths of Leadership • Management Myth • Entrepreneur Myth • Knowledge Myth • Pioneer Myth • Position Myth Leadership 101 John Maxwell
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Agile Break Out Savor Surprises Brain Power Mindset Change
Leadership Traits 26
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2021 Housing & Nurse Managers' Education Series
Consulting | Talent | Training | Resources
“A leader isn’t good because they’re right; they’re good because they’re willing to learn and to trust. This isn’t easy stuff.” Stanley McChrystal - 4-star general This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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Drive Change and Innovation Ignite and Inspire
LEAPS -Soren Kaplan
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2021 Housing & Nurse Managers' Education Series
Listen
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Explore
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2021 Housing & Nurse Managers' Education Series
Act
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Persist
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2021 Housing & Nurse Managers' Education Series
Seize
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INNOVATION INSPIRATION A Leader’s Choice
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2021 Housing & Nurse Managers' Education Series
Marble Jar Moment
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Consulting | Talent | Training | Resources
Connect Involve Talk Listen Show Share This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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2021 Housing & Nurse Managers' Education Series
Team Building
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Simple Paper Fold 1 sheet of paper Eyes closed Follow instructions Open eyes Conclusion Open mind and creativity
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2021 Housing & Nurse Managers' Education Series
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Consulting | Talent | Training | Resources
This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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2021 Housing & Nurse Managers' Education Series
Consulting | Talent | Training | Resources
This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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Face Challenges Model-Set the Tone Positivity
Motivate
Emerging Leaders
Passion Inspire
3/30/2021
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2021 Housing & Nurse Managers' Education Series
Consulting | Talent | Training | Resources
Passion
This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only
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Obstacles to Opportunities
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2021 Housing & Nurse Managers' Education Series
Ignite ◦ Engage your heart ◦ Reprogram your mind ◦ Take a break ◦ Remember the impact you make ◦ Learn
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2021 Housing & Nurse Managers' Education Series
INSPIRE
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Disclaimer ◦ “This presentation provided is copyrighted information of Pathway Health. Please note the presentation date on the title page in relation to the need to verify any new updates and resources that were listed in this presentation. This presentation is intended to be informational. The information does not constitute either legal or professional consultation. This presentation is not to be sold or reused without written authorization of Pathway Health.”
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2021 Housing Managers and Nurse Managers Virtual Education Series
SURVEY PREPARATION & SUCCESS/ELECTRONIC MONITORING April 6, 2021
Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc.
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INTRODUCTIONS Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc. Doug Beardsley has been involved in the field of long-term care since 1982, when he became a nursing home administrator. Mr. Beardsley has a Bachelor of Science degree in healthcare administration from the University of Wisconsin–Eau Claire. His experience includes 20 years as a nursing home administrator, three years as a long-term acute care hospital CEO, manager of an in-house LTC pharmacy, and other long-term care related activities. Mr. Beardsley has been the vice president of member services with Care Providers of Minnesota since 2005, where he is responsible for the regulatory activities pertaining to nursing facilities, home care, housing with services, assisted living, and hospice.
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
SURVEY PREPARATION & SUCCESS Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc.
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As you know, we are in the middle of a transition from: Registered Housing with Services + Arranged Comprehensive Home Care Provider = Assisted Living to Assisted Living License or Assisted Living with Dementia Care License 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
I will try to point out the differences that we are aware of, regarding the survey process in the current model as well as the model that will exist after 8-1-2021.
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Current Red Roof Assisted Living
• An apartment—with all the landlord/tenant rights of any apartment • A registered housing with services establishment—registered with MDH’s Health Regulation Division (annual registration is required) • Has an arranged home care provider (internal or external) identified with MDH • May have elected with MDH to operate a special care unit or special program for Alzheimer’s or related disorders • May have elected with MDH to use the term “assisted living” • Has filed a Uniform Consumer Information Guide (UCIG) 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Current Red Roof Assisted Living • Red Roof Assisted Living MUST identify an “arranged home care provider”. • The home care provider may or may not have common ownership with Red Roof.
04/06/2021
Care Provider
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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For the most part, it is the HOME CARE PROVIDER that is surveyed by MDH, not the HWS or AL. Care Provider
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
There are 4 types of home care in Minnesota: • Registered home management • Basic licensed home care • Comprehensive licensed home care • Comprehensive with Medicare certification
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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BASIC HOME CARE LICENSE Assistive tasks provided by licensed or unlicensed personnel that include: 1. Assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing; 2. Providing standby assistance; 3. Providing verbal or visual reminders to the client to take regularly scheduled medication, which includes bringing the client previously set-up medication, medication in original containers, or liquid or food to accompany the medication; 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
BASIC HOME CARE LICENSE Assistive tasks provided by licensed or unlicensed personnel that include: 4. Providing verbal or visual reminders to the client to perform regularly scheduled treatments and exercises; 5. Preparing modified diets ordered by a licensed health professional; and 6. Assisting with laundry, housekeeping, meal preparation, shopping, or other household chores and services if the provider is also providing at least one of the above services. 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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QUIZ Does a home care provider licensed as BASIC need a nurse on staff?
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
QUIZ
NO 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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COMPREHENSIVE HOME CARE LICENSE Can provide all of the BASIC license tasks, plus:
1. Services of an advanced practice nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker; 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
COMPREHENSIVE HOME CARE LICENSE Can provide any of the BASIC license tasks, plus:
2. Tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person's scope of practice; 3. Medication management services; 4. Hands-on assistance with transfers and mobility;
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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COMPREHENSIVE HOME CARE LICENSE Can provide any of the BASIC license tasks, plus:
5. Assisting clients with eating when the clients have complicating eating problems as identified in the client record or through an assessment, such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be fed; or 6. Providing other complex or specialty healthcare services. 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
QUIZ Does a home care provider licensed as COMPREHENSIVE need a nurse on staff?
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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QUIZ
YES 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
“The RN must be available in-person or via phone, text, email, etc. whenever delegated nursing tasks are being performed.”
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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The 4th type of home care is a
MEDICARE-CERTIFIED HOME CARE AGENCY • In Minnesota, this must be a licensed COMPREHENSIVE home care provider with an additional Medicare certification • Must comply with both state and federal requirements • Able to bill Medicare for skilled services 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
By the numbers… • 1,287 HWS with AL designation • 814 HWS with AL designation and memory care • 1,274 comp. home care • 282 temp. comp. home care •
For comparison, there are 364 nursing facilities and 129 hospitals in MN
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REVIEW
• Housing with services and AL • Scope of home care services • Types of home care in MN
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
SURVEYS - Current
• HWS requirements to be surveyed by MDH • Comprehensive home care provider requirements to be surveyed by MDH 23
MDH Surveys - Current • Within 12 months of issuing a new home care license (limited exception)—six months after a CHOW • At least every three years thereafter (statute—but not occurring) • Complaint investigations are an entirely different issue—conducted as-needed, based on triaged reports from the Minnesota Adult Abuse Reporting Center (MAARC) and investigated by the lead investigative agency (OHFC for HCALP) 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
MDH Surveys - Current • 2016: 196 comprehensive HC providers surveyed • 2017: 191 comprehensive HC providers surveyed • 2018: 235 comprehensive HC providers surveyed • 2019: 103 comprehensive HC providers surveyed in first six months • Note—these are providers surveyed—not number of surveys conducted, which are over 600 per year (resurveys included) 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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MDH Surveys - Current • MDH must survey approximately 125-150 initial licensed providers per year (new licensees with one-year deadline for survey) PLUS • CHOW surveys (approx. 50 per year?) six-month deadline for survey PLUS • MDH needs to survey approximately 440 comprehensive HC providers per year in order to achieve an every-three-year compliance cycle as mandated in statute 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
13
2021 Housing Managers and Nurse Managers Virtual Education Series
This number will jump to 600-700 per year in August 2021 for everyother-year surveys!
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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MDH Surveys: Housing with Services Requirements - Current • • • • • •
Housing managers education (30 hours every two years) Required dementia training Emergency preparedness Use of the term assisted living (check your marketing materials and website) Uniform Consumer Information Guide (UCIG) 22 required elements in your HWS written contract
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
MDH HWS Surveys: Housing Managers Education Current • • • • • •
30 hours every two years HWS manager is the person designated by the HWS owner Topics “relevant to the operations of the housing with services establishment and the needs of its tenants” Maintain records for three years No pre-approval or CEUs needed Other licensed CEUs may be applied
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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MDH HWS Surveys: Required Dementia Training
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
MDH HWS Surveys: Emergency Preparedness - Current Eight Required Elements
Each HWS must: 1. Have a written emergency disaster plan that contains: a) A plan for evacuation b) Addresses elements of sheltering in-place c) Identifies temporary relocation sites for tenants d) Details staff assignments in the event of a disaster or an emergency 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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MDH HWS Surveys: Emergency Preparedness - Current Each HWS must: 2. Post an emergency disaster plan prominently 3. Provide building emergency exit diagrams to all tenants upon signing a lease 4. Post emergency exit diagrams on each floor 5. Have a written policy and procedure regarding missing tenants (elopements)
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
MDH HWS Surveys: Emergency Preparedness - Current Each HWS must: 6. Provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter—staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on-site
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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MDH HWS Surveys: Emergency Preparedness - Current Each HWS must: 7. Offer emergency and disaster training to all tenants annually 8. Conduct and document a fire drill or other emergency drill at least every six months—to the extent possible, drills must be coordinated with local fire departments or other community emergency resources
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
MDH HWS Surveys: Other… • Use of the term “assisted living” (check your marketing materials) • Uniform Consumer Information Guide (UCIG) • 22 required elements in your HWS written contract 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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MDH Comprehensive Home Care Surveys - Current Types of surveys: • • • •
Full survey Core survey Follow-up survey (re-survey) Complaint survey/investigation
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
MDH Comprehensive Home Care Surveys - Current • Full survey: HCALP, MDH Health Regulations Division • Core survey: HCALP, MDH Health Regulations Division • Follow-up survey: HCALP, MDH Health Regulation Division • Complaint Investigation: OHFC, MDH Health Regulation Division, or county adult protective services, or law enforcement, or a combo platter
04/06/2021
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Survey Basics - Current • Unannounced • Generally only one surveyor present, unless training is occurring • Typically takes 1–4 days ; 3 days average
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Survey Basics - Current Length of survey depends, based on: • • • • •
Number of locations served by the licensee Number of home care clients Extent of issues discovered Complexity of care being provided Preparedness of the provider!
04/06/2021
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So What is Changing in August? One survey for the ALL – no separation from HWS and Comprehensive Home Care. Surveys every TWO years. Home Care elements remain the same, plus additional requirements. 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
So What is Changing in August? Building inspections (new!) Dementia Care Requirements (new!) Emergency Preparedness Requirements (new!) New Infection Control Section of Statue 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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So What is Changing in August? New disclosure forms New contract requirements New assessment elements New termination requirements 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
So What is Changing in August? Each site gets own independent survey – no more multiple sites under one home care licensed New AL Bill of Rights New Dementia Care Training 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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In theory… Everyone who converts to ALL or ALL with Dementia Care should experience a License Survey and a Building Survey by July 31st 2023.
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Survey Basics
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Survey Basics • The surveyor will ask for a series of documents upon entrance… this should not come as a surprise! • How will the information be gathered? • Who will gather it if the home care nurse manager is not in? • Consider creating a “survey binder” 04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
MDH Guide to the Survey Process and Introduction
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Entrance Conference Letter – Have Most Pre-Filled out! 04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Entrance
Interview Staff
Receive 2567
Building Tour
Interview Clients
Implement Changes
Client & Staff Observations
Document Review
Resurvey
Medication Observation
Exit Conference
Complete Survey Process
Conference
04/06/2021
(fines)
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
Client Observation and Record Review
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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SURVEY OUTCOMES • Averaging 12–13 correction orders per survey • We have seen deficiency-free surveys • We have seen surveys with 35+ correction orders • Multiple re-surveys are not uncommon • Stipulation orders with conditions
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Survey Outcomes • Correction orders: A correction order (also known as a licensing order) may be issued whenever the surveyor finds upon survey or during a complaint investigation that a home care provider, a managerial official, or an employee of the provider is not in compliance with sections of home care statutes • The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Survey Outcomes • Correction orders: The survey form indicating correction orders must be sent to the provider within 30 calendar days after the survey exit date
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Survey Outcomes • Correction orders: The provider needs to implement a system improvement to correct each identified issue of noncompliance • The noncompliance must be completed within the time period identified on the survey document (for example: 21 days) • Surveyors will not tell you HOW to fix an issue, only what is not in compliance 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Survey Outcomes • A plan of correction does not need to be submitted to MDH for review, acceptance, or approval • However, the home care provider must document any actions taken to comply with the correction order • Surveyors may request a copy of this documentation (and they will upon resurvey) 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Survey Outcomes • Don’t wait for a surveyor to ask for your documentation! • Have it ready, organized, and accurate— show your work! • How did you implement a quality improvement process? What have you changed since the survey to come into compliance? 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Follow-Up Surveys (re-survey) For providers that have Level 3 or Level 4 violations, or any violations determined to be widespread, MDH shall conduct a follow-up survey within 90 calendar days of the survey Follow-up surveys should not be a surprise! You should be ready with system corrections made! 04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Follow-Up Surveys (re-survey) • Follow-up surveys are intended to verify you have solved the identified correction order—both the individual finding and the system that failed to produce compliance • Once in your building, surveyors have the right to issue any new correction orders based on what they observe • Make it easy for them to get in-and-out of the followup survey! 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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2021 Housing Managers and Nurse Managers Virtual Education Series
Survey Exit Date Within 30 days MDH must send 2567 (correction orders)
Days indicated on 2567
Provider has XX days to correct identified correction orders Within 90 days MDH conducts follow-up survey for Level 3, Level 4, or widespread findings
Within 15 days Provider has opportunity to request any reconsiderations after receipt of 2567
Within Reconsideration must be 60 Determined days
04/06/2021
PASS or FAIL Start all over if FAIL
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Survey Findings Letter • • •
04/06/2021
Dates of survey Fines (if imposed) Explanation of the reconsideration process
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Survey Findings • • • • • • • 04/06/2021
Infamous 2567 form! NOT designed for home care Does NOT need to be signed Does not need to have plans of correction Does NOT need to be returned to MDH Half is left blank, doubling the size of the document Stupid form
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Survey Findings • Identifies: • • • •
04/06/2021
Statute reference Examples of deficient observed practice Scope and level for each correction order Compliance deadline for each correction order
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Levels and Scopes • Each correction order is assigned a Level and Scope •
Level 1 is a violation that has no potential to cause more than a minimal impact on the client and does not affect health or safety
•
Level 2 is a violation that did not harm a client's health or safety but had the potential to have harmed a client's health or safety, but was not likely to cause serious injury, impairment, or death
04/06/2021
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Levels and Scopes • Each correction order is assigned a Level and Scope •
Level 3 is a violation that harmed a client's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death
•
Level 4 is a violation that results in serious injury, impairment, or death
04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Levels and Scopes • Each correction order is assigned a Level and Scope •
•
•
Isolated, when one or a limited number of clients are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally Pattern, when more than a limited number of clients are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly but is not found to be pervasive Widespread, when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the clients
04/06/2021
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Levels and Scopes Level 4
J
K
L
Level 3
G
H
I
Level 2
D
E
F
Level 1
A
B
C
Isolated
Pattern
Widespread
04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
SURVEY OUTCOMES Beginning July 1, 2019, all Level 3 ($1,000) and Level 4 ($5,000) findings will be issued a fine with no opportunity to correct prior to the fine; Level 2 ($500) findings may be fined without an opportunity to correct (widespread or impact?)
71
But there’s more! In addition to fines, MDH may also impose: • Immediate temporary suspension of a home care license • Immediate suspension of a home care license • Issue conditions on the license, such as: • Require consultation • Require supervision • Require training • Require reports to be submitted • Prohibit taking new clients for a period of time 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
REVIEW • • • • • • • • •
Housing with Services and AL Scope of home care services Types of home care in MN Types of surveys Select survey forms Survey timelines Survey process Survey communications Survey outcomes
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So the question is…
04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
WHAT PROBLEMS ARE SURVEYORS CITING DURING SURVEYS?
04/06/2021
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Answer: A BUNCH OF STUFF
04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
My goal is to help you learn from the “mistakes” or ignorance of others. If other providers are having difficulty with a particular regulation or statute, there’s a good chance you may also be noncompliant in that area. 04/06/2021
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Correction Orders Issued in 35% or More of Surveys REGULATION
% of Surveys
Contents of Service Plan TB Prevention and Control Individualized Treatment/Therapy Mgt Plan Employee Records Individualized Medication Mgt Plan Provision of Medication Mgt Services Comprehensive Assessment and Monitoring Quality Management Individual Abuse Prevention Plan BOR - Accepted Standards Practice Contents of Client Record Documentation of Administration of Medication Policies and Procedures – Treatments and Therapy Content of Orientation 04/06/2021
50% + 50% + 50% + 50% + 40% - 50% 40% - 50% 40% - 50% 40% - 50% 30% + 30% + 30% + 30% + 30% + 30% +
Let’s deal with these “easy” ones first
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Let’s Address the “EASY” Ones First Employee Records 50 +% • Paper compliance and easy to audit! • Common issues • • • •
No job descriptions No annual performance review No background checks Incomplete required documentation
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Let’s Address the “EASY” Ones First Quality Management 40 – 50%% • Kind of a stupid title • Really means a documented Performance Improvement Project or Quality Improvement Project
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Let’s Address the “EASY” Ones First Quality Management 40% • The home care provider shall engage in quality management appropriate to the size of the home care provider and relevant to the type of services the home care provider provides. The quality management activity means evaluating the quality of care by periodically reviewing client services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to clients. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal. 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Let’s Address the “EASY” Ones First Root Cause Analysis
04/06/2021
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Let’s Address the “EASY” Ones First Quality Management 40 – 50% • Document the home care issue/problem/opportunity you are trying to improve • Gather data/baseline • Brainstorm potential system improvements • Implement/pilot and test the changes—measure • Make adjustments • Fully implement (and celebrate/praise) • Measure to determine if improvement held over time 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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Let’s Address the “EASY” Ones First Quality Management 40 – 50%% • Look at your complaint/concern log as a possible starting point—see if you can reduce the frequency of your #1 complaint! • Ask your staff what they think would improve client satisfaction or increase their ability to do the job better!
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Let’s Address the “EASY” Ones First Quality Management 40 – 50%% • Under the “current” system, the quality management project needed to relate to “home care services.” • Under ALL, there is no such restriction.
04/06/2021
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Let’s Address the “EASY” Ones First Policies and Procedures—Treatments and Therapies 30% - 40% • Two required elements: 1.Must develop, implement, and maintain up-to-date written treatment or therapy management policies and procedures 2. Policies must address… 04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Let’s Address the “EASY” Ones First Policies and Procedures—Treatments and Therapies 30% – 40% 2. Policies must address… a) Requesting and receiving orders or prescriptions for treatments or therapies b) Providing the treatment or therapy c) Documenting of treatment or therapy activities d) Educating and communicating with clients about treatments or therapy they are receiving e) Monitoring and evaluating the treatment and therapy f) Communicating with the prescriber 04/06/2021
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Let’s Address the “EASY” Ones First • Policies and Procedures—Treatments and Therapies 30% - 40% • Common survey findings: • • • •
Employee B confirmed there were no treatment and therapy policies and procedures developed or implemented, to include the required content Verified the following treatment and therapy management policies had not been developed Employee A confirmed the treatment and therapy policies and procedures were not developed to include… The licensee's policies and procedures for treatment and therapy management lacked the following…
04/06/2021
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
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www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
Let’s Address the “EASY” Ones First Content of Orientation 30% - 40% • Simply need to follow the statute • Specific list of required elements • Have a checklist of elements • Document
04/06/2021
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That leaves us with 10 more “complex” correction orders! % of Surveys Cited
REGULATION Contents of Service Plan
50% +
TB Prevention and Control
50% +
Individualized Treatment/Therapy Mgt Plan
50% +
Individualized Medication Mgt Plan
40% - 50%
Provision of Medication Mgt Services
40% - 50%
Comprehensive Assessment and Monitoring
40% - 50%
Individual Abuse Prevention Plan
30% +
BOR - Accepted Standards Practice
30% +
Contents of Client Record
30% +
Documentation of Administration of Medication
30% +
04/06/2021
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90
www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.4791 Subd. 9 (f) Contents of Service Plan
50% + of Surveys
• Service plans are completed no later than 14 days after initiation of home care services • The current signed service plans “match” the services you are providing to the client • Client needs change, and when the services you provide change to respond to these needs, so must the service plan be changed or be updated—in other words, the service plan is “accurate” • Service plans contain all the required “elements” 04/06/2021
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144A.4791 Subd. 9 (f) Contents of Service Plan
• • • • • • • •
Signed Info on ombudsman Info on rate change notice Description of services provided Fees for services provided Frequency of services provided ID of staff who will perform services Schedule of monitoring and reassessments (90 days and changes in condition) 04/06/2021
50% + of Surveys
• Frequency of staff supervision and who will supervise (30 days after hire and as necessary) • Contingency plan that includes: • Action if services not provided • Provider contact information • Client emergency names for emergencies and for signing • Circumstances when 911 will not be called and how you will respect any advance directives of the client CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
92
www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.4791 Subd. 9 (f) Contents of Service Plan
50% + of Surveys
• Tip: • Review the service plan when you conduct your every 90-day assessments—does it still match what you are doing? • Based on the assessment, are additional services recommended?
04/06/2021
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144A.4798 Subd. 1 Tuberculosis (TB) prevention and control
50% + of Surveys
Failure to have all the following elements documented: 1. Identify an individual or team responsible for TB infection control 2. Have a current written TB infection control plan 3. Document a current facility TB community risk assessment 4. Conduct initial and ongoing TB healthcare worker education 5. Conduct baseline screening of healthcare workers and regularly scheduled volunteers, including a screening of TB symptoms and testing using a properly administered and documented two-step TST or IGRA blood test 04/06/2021
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94
www.careproviders.org (952) 854-2844
47
2021 Housing Managers and Nurse Managers Virtual Education Series
144A.4793 Subd. 3 Individualized treatment or therapy management plan 50% + of Surveys
Lacked at least one of the five required elements of a treatment and/or therapy plan: 1. A statement of the type of services to be provided 2. Documentation of specific client instructions 3. Identification of treatment or therapy task that will be delegated to unlicensed personnel 4. Procedures for contacting a RN or other health professional if problem arises 5. Any client-specific requirements related to documentation, verification treatment or therapy was completed as prescribed, and monitoring to prevent possible complications or adverse reactions 04/06/2021
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144A.4793 Subd. 3 Individualized treatment or therapy management plan 50% + of Surveys
Common treatments or therapies involved in this correction order… • TED socks/compression stockings • Daily exercises ordered • Daily ROM • Daily weights • Daily ambulation ordered • Leg elevation treatment • Braces & splints • Ace wraps • Blood glucose monitoring • INR management 04/06/2021
• • • • • • • • • •
Oximeters Catheter care Cough assist Trach care G-Tube CPAP/BiPAP Wound care Weekly vital signs Oxygen Blood pressure monitoring
CARE PROVIDERS OF MINNESOTA | Leading Members to Excellence | #CPMEducates
96
www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.4792 Subd. 5 Individualized medication management plan
40% - 50% of Surveys
The provider must develop and maintain a current individualized medication management record for each client based on the client's assessment that must contain the following eight elements: 1. A statement describing the medication management services that will be provided; 2. A description of storage of medications based on the client's needs and preferences, risk of diversion, and consistent with the manufacturer's directions; 3. Documentation of specific client instructions relating to the administration of medications; 4. Identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis; 04/06/2021
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144A.4792 Subd. 5 Individualized medication management plan
40% - 50% of Surveys
The provider must develop and maintain a current individualized medication management record for each client based on the client's assessment that must contain the following eight elements: 5. Identification of medication management tasks that may be delegated to unlicensed personnel; 6. Procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; 7. Any client-specific requirements relating to documenting medication administration; and 8. Verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions 04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.4792 Subd. 2 Provision of medication management services
40% - 50% of Surveys
• No medication management assessment documented • Medication management assessment was not done prior to managing medications • Lacked evidence the RN conducted the medication assessment face-to-face with the client • No documentation regarding the plan to prevent the diversion of medications (controlled substances)
04/06/2021
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99
144A.4792 Subd. 2 Provision of medication management services
40% - 50% of Surveys
• Medication management assessments lacked the following:
• Identification and review of all medications the client is known to be taking • Indications for medications • Side effects • Contraindications • Allergic or adverse reactions and actions to address these issues • Interventions needed to prevent diversion
04/06/2021
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100
www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.4791 Subd. 8 Comprehensive Assessment and Monitoring
40% - 50% of Surveys
TWO reasons for this correction order—Reason 1: Timing: Failure to meet the timing requirements of assessments and monitoring: • • • •
Prior to medication management services Within 5 days Within 14 days Every 90 days thereafter
04/06/2021
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144A.4791 Subd. 8 Comprehensive Assessment and Monitoring
40% - 50% of Surveys
TWO reasons for this correction order—Reason 2: Updating & accuracy: Failure to reassess due to change in condition or as needed—common triggers include the following: • Falls • Injuries • Bruising • Skin Tears • Return from ER or hospitalization • Move to secured unit due to change in cognitive function • Note: relationship to incident reports and communication books 04/06/2021
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102
www.careproviders.org (952) 854-2844
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.479 Subd. 6 (b) Individualized Abuse Prevention Plan
30% - 40% of Surveys
• Abuse prevention plans not done at all • Susceptibility of client does not match the plan (change in condition) • Incident reports indicate susceptibility that did not change provider’s plan/approach
04/06/2021
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144A.479 Subd. 6 (b) Individualized Abuse Prevention Plan
30% - 40% of Surveys
• Tip: Consider reviewing and updating when appropriate, the abuse prevention plan after each incident report and at each assessment/reassessment
04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.479 Subd. 6 (b) Individualized Abuse Prevention
Blindness Cerebral palsy Dialysis Dementia, confusion, cognitive deficits • Traumatic brain injury • Parkinson’s • Socially inappropriate behaviors (sexual) • • • •
• Hallucinations, delirium • Elopements • Wandering into other tenants’ apartments • Aggressive behavior (verbal, physical, threatening, combative) • Inability to summon for assistance
04/06/2021
30% - 40% of Surveys
• Inability to follow directions • Inability to communicate needs • Behavior symptoms • Sensory limitations • Chronic pain • Suicidal threats • Frequent falls or bruising
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144A.44 Subd. 1(2) BOR—Acceptable Standards of Practice
30% - 40% of Surveys
The right to receive care and services according to a suitable and up-to-date plan, and subject to accepted healthcare, medical, or nursing standards, to take an active part in developing, modifying, and evaluating the plan and services. Actions in the following area were conducted outside of accepted standards of practice: • Infection control: Handwashing, glucometer cleaning, gloving, etc. • Side rails: Lack of assessment, documentation of education with client/family, compliance with FDA dimensional guidance, proper installation and maintenance • Alarms and restraints: Used inappropriately, no P/P, no assessments for use • Falls, bruises, and skin tears: Lack of evaluation, or reevaluation competed by a RN to assess for causative factor to determine individualized intervention to reduce future incidents (commonly documented in incident and communication books, but no followup done) • Oxygen: Who is responsible, proper storage, who refills and orders? 04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
144A.4794 Subd. 3 Contents of Client Record
30% - 40% of Surveys
The client record (chart or medical record) failed to include one or more of the 15 required elements. Example of missing information include: Description of pressure ulcers, including when discovered and action taken Documentation of wounds Target behaviors Incidents involving the client Significant changes in condition prior to hospitalization Significant changes in condition without hospitalization and actions taken in response • Discharge information, discharge summary, date of death
• • • • • •
04/06/2021
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144A.4794 Subd. 3 Contents of Client Record
30 – 40% of Surveys
The client record (chart or medical record) failed to include one or more of the 15 required elements. Example of missing information include: • Incidents, such as choking, elopement, and other situations of significance found in incident reports • Dressing, grooming, ambulation, toileting (per service plan) • Initiation of hospice services • Increased dementia or confusion • Client refusals of services
04/06/2021
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144A.4792 Subd. 8 Documentation of Administration of Medications
30% - 40% of Surveys
• PRNs: • Given but not documented • Indications for use not documented • Effectiveness not documented • Medications given but not documented as given • Transcription errors • No reason documented for not giving med or follow-up to meet client needs • Oral and/or inhalant medications administered but not documented • Medications documented as given before they were administered • Documentation lacked required elements for medication documentation • Discrepancies between labels, MARs, and orders 04/06/2021
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Whew! 04/06/2021
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What if I do not agree with my correction order? Request a reconsideration!
111
Reconsiderations Your chance to “Get it Right!” • • • •
May challenge the correction order May challenge the level of the correction order May challenge the scope of the correction order May challenge the fine issued
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Reconsiderations • A written request for a reconsideration must be received by the commissioner (MDH) within 15 calendar days of the correction order receipt date • MDH shall respond in writing to the request from a home care provider for a correction order reconsideration within 60 days of the date the provider requests a reconsideration 04/06/2021
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Reconsiderations: MDH Options • Supported in full—no changes • Supported in substance, the correction order is supported, but one or more findings are deleted or modified without any change in the citation • Correction order is amended by changing the correction order to the appropriate statutory reference • Correction order is rescinded • Fine is amended • Level or scope of the citation is modified 04/06/2021
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Reconsideration Outcomes Outcomes from Reconsideration (FY2018)
#
%
Supported in full with no deletion of findings
34
40.5%
Supported in substance, correction order supported, one or more findings deleted or modified without any change in citation
32
38.1%
Order cited incorrect HC licensing requirement, order amended by changing to correct citation
2
2.4%
Fine is amended
1
1.2%
Correction order is rescinded
6
7.1%
Level or scope of citation is modified based on reconsideration
6
7.1%
04/06/2021
Almost 60% of the reconsiderations requested resulted in some change to the correction order. 7% resulted in the correction order being entirely deleted. 81 total correction orders were disputed.
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But Wait… There’s More! 04/06/2021
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Office of Health Facility Complaints 117
OHFC • OHFC does not conduct the initial or every-three-years surveys (or new two years) • Responds to complaints from clients, families, and the public. • Responds to self-reports of suspected neglect, abuse, or exploitation (theft) from providers (including home care) • Investigates both home care statutes and the Minnesota Vulnerable Adults Act (maltreatment—neglect, abuse, and exploitation) 04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
OHFC • Unannounced investigations • Less communications due to the nature of the investigation • Will interview clients, family, and staff • VAA findings are unsubstantiated, inconclusive, or substantiated • May also include state correction orders 04/06/2021
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OHFC • Investigating violations of the MN Vulnerable Adults Act • Investigating state home care licensing violations • Investigating HWS requirements violations 04/06/2021
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OHFC • Violations of the MN Vulnerable Adults Act will be labeled as maltreatment and identified as neglect, abuse, or exploitation. • Findings of maltreatment can be substantiated against: • Individual(s) • Facility/provider • Both individual(s) and the facility/provider 04/06/2021
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OHFC: “Typical” Substantiated Findings in Assisted Living Neglect
• Failure to re-order medications • Failure to give medications as ordered • Elopements • Multiple falls, bruises, skin tears without intervention • Failure to address changes in condition • Failure to maintain oxygen services • Failure to provide care and services • Pressure ulcers • Failure to check on clients • Failure to supervise violent clients • Supervision of sexual activities
Abuse
• Staff that hit or slapped a home care client • Verbal abuse towards a home care client • Sexual abuse with a home care client
04/06/2021
Exploitation
• Theft of gift cards or credit cards • Theft of checks • Theft of cash • Theft of jewelry or other personal belongings • Theft of medications (usually controlled substances)
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2021 Housing Managers and Nurse Managers Virtual Education Series
OHFC and the Bill of Rights Issue • The Minnesota home care bill of rights provides the right for clients to be free from maltreatment, including neglect, abuse, or exploitation • This means that the home care provider will be cited for failing to ensure those rights when a “bad actor” engages in maltreatment of a home care client—even if the home care provider did nothing wrong (foreseeability) • One cannot use staff to be in regulatory compliance without having their negative actions also reflect on the home care provider
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MAARC • Mandated reporters under the MN Vulnerable Adults Act • Maltreatment: • Suspected neglect • Suspected abuse • Suspected exploitation/theft • Must report to MAARC within 24 hours— MARRC will generally forward to OHFC as the lead investigative agency 04/06/2021
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Random • CLIA
04/06/2021
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Wrap Up • Survey process • Survey findings • Survey preparedness
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Survey Success
• • • • • • • • • • • • •
Know the statutes—knowledge is power First impressions, how would you respond? Train staff on what to say (and not say) during a survey Observations should not scare staff—practice! Audit, Audit, Audit Learn from the mistakes of others Be polite, surveyors are people too Ask clarifying questions—find the correct answers Provide additional information and guidance to surveyors Limit computer access to what is needed Have survey material ready—and have a backup person! Use the MDH forms when possible Use the reconsideration process 04/06/2021
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Use MDH Forms When Possible
04/06/2021
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Look at Surveys
04/06/2021
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Look at Surveys
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Questions? 04/06/2021
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Doug Beardsley Vice President of Member Services dbeardsley@careproviders.org 952-851-2489
134
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ELECTRONIC MONITORING Doug Beardsley, Vice President of Member Services Care Providers of Minnesota, Inc.
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Electronic Monitoring: Handouts • • • • •
Electronic Monitoring 144.6502 (the law) Electronic Monitoring Sample Facility One-Pager Electronic Monitoring Sample Facility Policy Electronic Monitoring F&Qs Electronic Monitoring Consent Forms:
• • • •
Resident Resident’s Representative Roommate Roommate’s Representative
04/06/2021
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Electronic Monitoring
• • • •
Background Timelines Requirements Q&As
04/06/2021
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Electronic Monitoring: Background • 2016: Legislative mandated workgroup • •
Report required by January 15, 2017 Report gave numerous recommendations, but no proposed legislation
• 2018: Some individual legislation brought forward, nothing passed • 2018: Governor-appointed group brings forward expansive elderreform bill, including electronic monitoring •
Bill is vetoed along with most bills by the governor
04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
Electronic Monitoring: Background • 2018: New commissioner of health, Jan Malcolm, assembles workgroups regarding various elder protection issues, including electronic monitoring • An electronic monitoring workgroup is convened by the Minnesota Elder Justice Center • •
The workgroup develops consensus electronic monitoring language Previous workgroup recommendations, previous legislative language, and best practices from other state electronic monitoring laws were all evaluated
04/06/2021
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Electronic Monitoring: Background • The consensus language was included in the 2019 Elder Care and Vulnerable Adult Protection Act • The bill passed in the 2019 legislative session • The bill was signed into law by the governor
04/06/2021
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Electronic Monitoring: Timelines
• Effective January 1, 2020 • Does not wait for assisted living licensure
04/06/2021
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Electronic Monitoring • What types of facilities does the law apply to? • Licensed nursing facilities • Licensed boarding care homes • Registered housing with services establishments that use the term “assisted living” (144G) or have disclosed a “special unit” on their registration • Effective August 1, 2021, all licensed assisted living facilities
04/06/2021
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Electronic Monitoring • What is electronic monitoring?
• The placement and use of an electronic monitoring device by a resident (or resident representative) in the resident's room or private living unit in accordance with…the electronic monitoring law.
04/06/2021
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Electronic Monitoring • What is an electronic monitoring device?
• “A camera or other device that captures, records, or broadcasts audio, video, or both, that is placed in a resident's room or private living unit and is used to monitor the resident or activities in the room or private living unit.”
04/06/2021
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Electronic Monitoring • What is an electronic monitoring device? • Can be hidden or out in the open—the law makes no distinctions
04/06/2021
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Electronic Monitoring • What is NOT considered an electronic monitoring device? • Facility-installed cameras in public areas of the building (lobby, entrances, corridors, dining rooms, etc.) or in areas intended for use only by staff (medication storage rooms) • Devices used to communicate with residents that are not intended to monitor the resident or activities in their room or private living unit (facetime, zoom, skype) 04/06/2021
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Electronic Monitoring
• What is and is not an electronic monitoring device is a moving target • New technologies will bring new questions • Intended use should remain consistent (“used to monitor”)
04/06/2021
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Electronic Monitoring • Why would a resident or family member want to install an electronic monitoring device? • • • • •
Monitor resident activities, including falls or repositioning Peace of mind regarding care and services Document and verify care and services are being provided as promised Deter suspected or potential maltreatment Document situations of maltreatment (neglect, abuse, or thefts (exploitation))
• Most electronic monitoring devices have been installed when the family did not believe their concerns had been heard or adequately addressed by the facility’s administration 04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
Electronic Monitoring • Resident protections • Facility cannot ban the use of electronic monitoring (check your policies) • Facility cannot refuse to admit or initiate the discharge of a resident regarding electronic monitoring • Facility cannot prevent installation or the use of electronic monitoring utilized consistent with the law • Facility cannot retaliate against a resident or family member for reasons surrounding electronic monitoring 04/06/2021
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Electronic Monitoring: The MN Law • Key elements: • Consent • Conditions on use of monitoring • Notification required •
• • • • •
Required Form
Notification options
Roommates/shared living space requirements Cost and installation Use of facility Wi-Fi Protections/use of recorded material Use in employee discipline
04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
Electronic Monitoring: Consent • Consent • Key to the law is the concept that a resident must consent to the use of electronic monitoring • If the resident is unable to provide consent due to cognitive issues, a substitute decision maker (resident representative) may be used…in this order: • • •
Court-appointed guardian Identified health care agent (145C.01 Subd.2) Other identified resident representative
04/06/2021
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Electronic Monitoring: Consent • A resident representative is: • a person who is not an agent of a facility or of a home care provider; • designated in writing by the resident; and • whose name is maintained in the resident's records on file with the facility. 04/06/2021
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Electronic Monitoring: Consent •
Consent must be executed in writing
•
Consent must be provided on a designated form
•
MDH developed the forms, working with the Office of Ombudsman for Long Term Care (OOLTC). Many versions were reviewed
•
MDH published the forms on December 24, 2019 and revised them on 1/20/20. They are available via MDH Bulletin 19-06: https://www.health.state.mn.us/facilities/regulation/infobulletins/ib19_6.html.
04/06/2021
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Electronic Monitoring: Consent
• MDH decided it was best to create FOUR versions of consent forms
04/06/2021
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2021 Housing Managers and Nurse Managers Virtual Education Series
Electronic Monitoring: Consent The four options are: • Resident Consent Form: used when a resident is consenting for herself or himself • Resident Representative Consent Form: used when a resident has a representative complete the consent process according to statute • Roommate Consent Form: used when the resident shares a room or living unit with another person and the roommate is consenting for herself or himself • Roommate Representative Consent Form: used when the roommate has a representative complete the consent process according to statute
04/06/2021
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Electronic Monitoring: Consent • If a resident representative is used for consent: • The resident must be offered the opportunity to affirmatively object to the electronic monitoring • The resident representative must explain a series of issues to the resident, including the type of electronic monitoring to be used, any conditions or limits the resident may desire, with whom the recordings may be shared, and the resident’s right to decline all recordings 04/06/2021
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Electronic Monitoring: Consent • The approved consent forms have many required elements: 1. Date 2. Who was present 3. Acknowledgement the resident did not affirmatively object 4. Source of resident representative’s authority 5. Roommate consent, if applicable 6. Type of electronic monitoring to be utilized
04/06/2021
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Electronic Monitoring: Consent 7. A list of possible conditions or exceptions for consideration regarding the use of the electronic monitoring device: • • • •
Prohibited audio recording Prohibited video recording Prohibited broadcasting of audio or video When to turn off or block the recording device (e.g., exams, procedures, dressing, bathing, visits by clergy, ombudsman, attorney, intimate partner, financial planner, visitor, etc.)
8. Signature box 04/06/2021
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Electronic Monitoring: Consent • Consent may be withdrawn at any time • Withdrawal of consent must be documented in the original consent and notification form
04/06/2021
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Electronic Monitoring: Notification • The signed consent, on the approved form, must be provided to the licensed facility prior to implementing electronic monitoring • However, there is an exception to the requirement to provide the notice to the licensed facility in advance of the electronic monitoring…
04/06/2021
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Electronic Monitoring: Notification • Exception to notice to facility… • If the resident or resident representative: 1. reasonably fears retaliation against the resident, or 2. submits a written concern to the facility regarding a concern prompting desire for placement of electronic monitoring, and does not receive a timely response, or 3. has already submitted a MAARC report, OHFC complaint, or police report regarding the resident’s concern prompting desire for placement of electronic monitoring. 04/06/2021
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Electronic Monitoring: Notification • Then the resident or resident representative may, instead of providing the advance notice to the facility, provide the signed consent and notice form to the Office of Ombudsman for Long-Term Care (OOLTC). • This notice to the OOLTC is only valid for a period of 14 days • On the 15th day, the 14-day exception notice expires, and notification must be provided to the facility 04/06/2021
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Electronic Monitoring: Notification • Office of Ombudsman for Long-Term Care has hired one FTE to oversee this new responsibility.
04/06/2021
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Electronic Monitoring: Notification • Exception to notice to facility… • During this 14-day period, the resident or resident representative has some additional responsibilities, such as timely contacting MAARC and law enforcement if the electronic device indicates evidence of suspected maltreatment • In other words, if they see suspected maltreatment, they must report it immediately
04/06/2021
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Electronic Monitoring: Notification • Exception to notice to facility… • During this 14-day period, if a facility discovers an electronic monitoring device, and the facility has not been provided a signed consent and notice form, the facility should contact the OOLTC to confirm that the OOLTC was provided a signed consent and notice form
04/06/2021
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Electronic Monitoring: Notification • Exception to notice to facility… • If neither the facility nor OOLTC have received a properly executed consent and notice form, the facility should contact the resident or resident’s representative to notify him/her that the electronic monitoring device is being used outside of the MN electronic monitoring law, and then request the resident or resident’s representative to disable or remove the device to protect the privacy rights of the resident until proper consent is received—Do not take the device away…it is not your property! 04/06/2021
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Electronic Monitoring: Roommates • All the same requirements apply to the roommate of a resident where electronic monitoring is intended to be implemented • If a roommate does not provide consent, then the electronic monitoring cannot proceed • If a roommate provides consent, and then later withdraws the consent, the electronic monitoring must cease. 04/06/2021
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Electronic Monitoring: Roommates • If a roommate does not consent, the facility must make reasonable attempts to accommodate the resident who desires electronic monitoring • Reasonable accommodations include, but are not limited to: • Offer to move to another room • Offer a private room (at resident’s expense) • Attempt to find alternative room every two weeks • Facility is not obligated to move roommate or provide free private room 04/06/2021
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Electronic Monitoring: Roommates • If a resident conducting authorized electronic monitoring gets a new roommate, the electronic monitoring must be removed by the resident or resident representative prior to the move-in of the roommate • Once the new roommate provides consent and notice, electronic monitoring may once again be placed in the room • If the new roommate does not provide consent and notice, the facility shall initiate reasonable accommodations for the resident 04/06/2021
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Electronic Monitoring: Devices • The cost of an electronic monitoring device is the responsibility of the resident or resident representative • The installation and maintenance is also at the expense of the resident or resident representative • Costs pertaining to the removal of the electronic monitoring devices is the responsibility of the resident or resident representative 04/06/2021
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Electronic Monitoring: Devices • If a facility provides free guest Wi-Fi, it must also make that Wi-Fi available for electronic monitoring. You cannot provide Wi-Fi for some resident purposes (e.g., streaming Netflix on an iPad), but deny access to it for electronic monitoring. Do not create roadblocks! • If a facility does not provide Wi-Fi to residents, the resident or resident representative will be responsible to contract and pay for such service (internet or Wi-Fi) for the electronic monitoring device (note: balance this decision with customer service and client/family expectations regarding services available) 04/06/2021
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Electronic Monitoring: Devices • Facilities should review their Wi-Fi policies • Best practice would be to have your secured business Wi-Fi separate from any guest Wi-Fi • What is the bandwidth capabilities of your guest Wi-Fi? • •
This may be limited in some areas of the state Cost of increasing bandwidth?
• Decide if guest Wi-Fi will be secured or not—if not secured, notify guest users of that fact 04/06/2021
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Electronic Monitoring: Devices • Electronic monitoring devices must be UL listed
• Extension cords and/or multi-tap surge suppressor strips must not be used in nursing facilities – per the NFPA Life Safety Code
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Electronic Monitoring: Signage • No signs are required outside or inside resident rooms where electronic monitoring is in use (this is a requirement in some states) • Signage requirement went into effect 1-1-20 • All facilities covered by this law (nursing facilities, boarding care homes, HWS/AL settings) must post signs at each facility entrance that is accessible to visitors that states: 04/06/2021
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Electronic Monitoring: Signage Electronic monitoring devices, including security cameras and audio devices, may be present to record persons and activities. 04/06/2021
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Electronic Monitoring: Signage • Type of sign, size of sign, font size, font type, font color, etc. are not delineated in the law • The facility is responsible for installing and maintaining the required signage • The signs give advance notice to staff and visitors that electronic monitoring may be present in the building
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Electronic Monitoring: Staff & Facility Responsibilities • If a resident or family member asks staff about electronic monitoring options or opportunities, who should staff refer them to within the facility? • If a consent form indicates any restrictions regarding when the electronic monitoring should be turned off or blocked, will you communicate those conditions to staff? Is the facility, or your staff, required to carry-out any identified conditions? Consider policy implications as well as customer service and person directed care implications. Untested waters! 04/06/2021
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Electronic Monitoring: Staff & Facility Responsibilities • Who, within the facility, should staff go to if they discover an electronic monitoring device has been installed in a resident’s living space? • Who in the facility will receive signed consent forms, and who will be responsible to contact the OOLTC to confirm a consent form was received by the OOTC when an electronic monitoring device is discovered when consent has not been provided to the facility?
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Electronic Monitoring: Staff & Facility Responsibilities • How will you make the authorized consent and notification forms available? The law requires you make them available. • How will you address or introduce electronic monitoring in your resident handbook or similar communications with residents and family members? The law requires facilities to inform residents of their option to conduct electronic monitoring. •
Assume residents and family member are unaware of the law
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Electronic Monitoring: Staff & Facility Responsibilities • Recommend staff training: • Always act in a manner where they assume they are being monitored by audio and video • • •
Verify staff understand they are prohibited from retaliating against a resident or others as a result of electronic monitoring having been initiated If staff will be accommodating restrictions, how will they know what restrictions are in place? Verify staff know that they are prohibited from tampering or destroying an electronic monitoring device
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Electronic Monitoring: Staff & Facility Responsibilities • Recommend staff training: • Verify staff know who at the facility they should contact regarding electronic monitoring questions • •
Verify staff know who at the facility they should refer a resident or family member to regarding electronic monitoring questions Review customer service expectations and your concern and grievance procedures with staff—remember that most electronic monitoring has occurred when family did not feel their concerns were listened to or adequately addressed
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Electronic Monitoring: Other • If a staff member is disciplined (or has proposed discipline) as a result of activity recorded via electronic monitoring: • the accused staff member must be given access to such evidence; • the accused staff member who obtains the recording or copy must not further disseminate it to any other person except as required by law; and • any copy of the recording must be returned to the facility or person who provided the copy when it is no longer needed for purposes of defending against a proposed disciplinary action. 04/06/2021
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Electronic Monitoring: Other • No person may access any video or audio recording created through authorized electronic monitoring without the written consent of the resident or the resident representative • Recordings may only be disseminated for the purposes of addressing health, safety, or welfare concerns of one or more residents
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Electronic Monitoring: Other • Admissibility of evidence: • Subject to applicable rules of evidence and procedure, any video or audio recording created through electronic monitoring may be admitted into evidence in a civil, criminal, or administrative hearing
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Electronic Monitoring: Wrap-Up • • • • • • •
Understand the law Verify signage has been installed at public entrances Designate who at the facility will be responsible for this topic Train staff on the law, including responsibilities and expectations Enhance your customer service program Enhance your response and action to concerns and complaints Verify your policies and procedures: • •
Do not prohibit electronic monitoring Prohibit retaliation resulting from the use of electronic monitoring
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Electronic Monitoring: Wrap-Up • Determine what your action steps are when you receive a consent form: •
Has the resident or resident representative expressed concerns regarding staff or care? Have those concerns been addressed?
•
• • •
Many previous examples of electronic monitoring have occurred due to a consumer belief the facility had failed to address concerns
How will you verify the electronic monitoring device is UL-approved and installed in a safe manner? How can you assist with the process (not create roadblocks to the use of the electronic monitoring device)? Are their restrictions/conditions on when the electronic monitoring is not to be used—if so, what is your plan – to assist or not to assist?
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Electronic Monitoring: Wrap-Up • Develop a procedure outlining who will verify that proper consent has been received by the facility when an electronic monitoring device is discovered, and if no consent and notification has been received by the facility… • Determine who will contact the OOLTC to verify that the OOLTC has a consent and notification on file—the date of such notification to the OOLTC should be documented, with the expectation that a copy of the consent and notification will be received by the facility within 14 days after the consent and notification was provided to the OOLTC 04/06/2021
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Electronic Monitoring: Wrap-Up • Determine how you will communicate this option with residents/resident representatives: • Admission packet information? • Resident handbook? • Flyer or notice? • Resident or family council meetings? • Determine how you will make available the approved consent forms 04/06/2021
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Electronic Monitoring: Wrap-Up • Unknowns: • Facility Wi-Fi bandwidth • Clergy, attorney, ombudsman, surveyor recordings? • Changing technology—will the law be applicable? • Staff responsibilities regarding client/representative limits or conditions on what is to be recorded— resident representative reactions (appearance the facility is refusing to cooperate) and potential for errors made by staff (forgetting to turn on or off).
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Electronic Monitoring: Wrap-Up • Unknowns: • How often will the 14-day notice to the OOLTC will be used vs. direct notification to the facility? • Staff reaction to the use of electronic monitoring • Family disagreements regarding the use of electronic monitoring • Issues surrounding the residents’ ability to provide consent • Frequency of use—will the law increase or decrease use? • Consequences to consumers for not following the law?
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Electronic Monitoring: Wrap-Up Remember that this is a relatively new law in Minnesota. We have the ability to “fine-tune” the law in the future if there are unintended negative consequences or the law is unworkable.
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Questions?
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Client Observation and Record Review: Comprehensive TEMPORARY LICENSED AND LICENSED HOME CARE PROVIDERS
Purpose
Minnesota Department of Health (MDH) surveyors use this form to document evidence of: • • • • •
Observations of client care and services; Medication management services; Treatment and therapy services; Nursing assessments; and Client and/or family interviews
Providers may use this document to self-audit. Statute references (with links to the Revisor’s website) occur throughout (e.g., 144A.4792, Subd. 1). Click on the link and scroll to the noted subdivision for information about the specific requirement(s). If you are working from a printed document all links can be found at: Home Care Statutes (https://www.health.state.mn.us/facilities/regulation/homecare/laws/index.html)
Provider Information Provider name: _______________________________________________ HFID: __________________ Date/Time of survey: __________________________________________________________________
Client Information Name: ___________________________________________ Identifier: _________________________ Diagnoses: ___________________________________________________________________________ Start of care: _______________________ Current service plan date: ____________________________
Surveyor Surveyor name(s): ____________________________________________________________________
Discharged Client Record Review ☐ ☐
Discharge summary [144A. 4794, Subd. 3 (14)] Disposition of medications [144A. 4792, Subd. 22 (c)]
Client Daily Life Review Caregiver observed: __________________________________________________ (name and identifier) Position/title: ________________________________________________________________________
HCALP-F5022C 07/09/2019
CLIENT OBSERVATION AND RECORD REVIEW: COMPREHENSIVE
Throughout the survey, surveyors observe staff as they provide services to clients. Surveyors interview staff and clients to evaluate and validate surveyor observations and findings. Areas reviewed include but are not limited to: ☐
☐
☐ ☐ ☐
☐ ☐
☐ ☐
Staff knowledge and implementation of the client’s service plan. Client’s individualized vulnerable adult or minor abuse prevention plan. Client was free from physical and verbal abuse. Client care needs including but not limited to durable medical equipment, tube feedings, pressure ulcers, blood glucose checks, insulin, oxygen, dialysis, hospice care and falls. Care and services were provided in accordance with accepted medical and nursing standards. Current standards of practice for infection control were followed, including but not limited to appropriate hand hygiene, handling and transporting linen to prevent spread of infection and the use of protective gloves when appropriate. Client was treated with courtesy, respect, and client’s rights were not violated. Staff listened and were responsive to client requests. (Note staff interaction with both communicative and non-communicative clients.) Medication administration and/or assistance with self-administration of medications.
☐
Client’s bathing, dressing, grooming and toileting needs were met.
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Other observations/interviews as deemed necessary (e.g., behaviors, cognition, mobility, demeanor, environment, etc.).
☐
Client was free from physical and/or chemical restraints.
Client Record Review Surveyors review client records to determine if documentation standards were met related to evaluation and assessments and the services the client received. ☐
Individual abuse prevention plan (IAPP) was current and included: ☐ An individualized assessment of client’s susceptibility to abuse by other individuals; ☐ Assessment of the client’s risk of abusing other vulnerable adults or minors; and ☐ Statements of the specific measures to be taken to minimize the risk of abuse to the client and other vulnerable adults or minors and risk of self-abuse. Date of most current IAPP: _________________ [144A.479, Subd. 6 (b)]
☐
Client assessments by a registered nurse (RN) or other licensed health professional (LHP) were completed as required. [144A.4791, Subd. 8 (a)(b)(c)] ☐ Initial assessment within 5 days of starting services. Date: _________________ ☐ Reassessment within 14 days of starting services. Date: ___________________ ☐ Ongoing client monitoring at least every 90 days. Dates: __________ , _________ , ________ or with a change in client’s condition. Date(s): ____________ , _____________
☐
Service plan was completed within 14 days of start of services and revised as needed. Date(s): _______________, ______________ [144A.4791, Subd. 9 (a) (b) (c) (d) (e) (f)]
☐ ☐
2
Service plan had all required content [144A.4791, Subd. 9 (f)] All services were provided and documented (ADLs, IADLs, medications and treatments) as noted in the client’s service plan. [144A.4791, Subd. 9 (c) and 144A.4794, Subd. 3] HCALP-F5022C 07/09/2019
CLIENT OBSERVATION AND RECORD REVIEW: COMPREHENSIVE
☐
Client-specific written instructions were present for delegated nursing procedures. [144A.4792, Subd. 7; and 144A.4793, Subd. 4] Date: _________________
☐
Documentation of client’s receipt (date and signature) and review of: ☐ Minnesota home care bill of rights ________________ [144A.4791, Subd. 1] ☐ Statement of home care services _________________ [144A.4791, Subd. 3]
☐
Written complaint notice ______________
[144A.4791, Subd. 11 (a) (b) (c)]
☐
Documentation of complaints received, if applicable, and resolution.
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Entries in the client’s record were current, authenticated and legible. [144A.4794 Subd. 1 (a)]
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Client records were kept confidential and secure. [144A.4794 Subd. 1 (b)] Significant changes or incident(s) and the actions taken in response were documented, (e.g. client falls, post-hospital, ER visits, any client deterioration) [144A.4791, Subd. 8 (c)]
Medication Management Services [144A.4792, Subd. 1-23] Surveyors review client’s record for compliance related to medication administration including all prescribed, non-prescribed, over-the-counter and dietary supplements taken by the client. ☐
RN developed and implemented an individual medication management plan prior to provision of services. [144A.4792, Subd. 2-7] Initial individual medication management plan date: _________________
☐
Individualized medication monitoring occurred when client had symptoms/issues related to medication.
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Reassessment occurred when the client presented with symptoms/issues that were medication related.
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Medication plan was current and the service plan was updated (if needed).
☐
☐
☐ ☐ ☐
3
Annual reassessment occurred. Date: ________________ Individual medication management plan included descriptions of: ☐ Medication management services provided by nurse and unlicensed personnel (ULP) (included PRN). ☐ Type of medication storage system, based on client needs. ☐ Specific written instructions for client’s medication administration. ☐ Person responsible for monitoring medication supplies and refills. ☐ Medication management tasks that may be delegated to ULPs. ☐ Procedures for staff to notify an RN when problems arose. ☐ Any client-specific requirements (e.g., parameters: blood sugar, blood pressure, pulse, etc.) Medication administration records were complete; medications were administered as ordered and documented correctly, or if not administered reasons were documented. (Record includes reasons to use PRN medications and their effectiveness.) [144A.4792, Subd. 8] Medication set-up and administration were documented. [144A.4792, Subd. 9] Documentation of medication administration was completed for client who was away from home. [144A.4792, Subd. 10 (a) (b)] HCALP-F5022C 07/09/2019
CLIENT OBSERVATION AND RECORD REVIEW: COMPREHENSIVE
☐
Prescriber’s orders were written and dated for medications administered and orders were complete. [144A.4792, Subd. 13]
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Medication orders were renewed at least every twelve months. [144A.4792, Subd. 14]
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Verbal orders were received only by a nurse or pharmacist, were entered into the client record and forwarded for signature by licensed prescriber. [144A.4792, Subd. 15]
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Electronically transmitted orders were recorded, communicated to the RN and placed in client record. [144A.4792, Subd. 16]
Treatment and Therapy Management Services [144A.4793, Subd. 1-6] Client’s record (including the service plan and treatment administration records) was reviewed for all prescribed treatments and therapies administered by the provider’s employee(s). Examples of treatments and therapies include but are not limited to using oxygen or a breathing apparatus or pulse oximetry, doing blood glucose checks or tube feedings, applying TED hose or splints, providing physical/occupational/speech-language therapy exercises, or wound care. Surveyors will also review maintenance procedures for equipment used in treatments and therapies.
Individual treatment and therapy management plan
☐ Service plan was current and updated with any changes. Date: _____________ [144A.4793, Subd. 3] ☐ RN or appropriate LHP developed a treatment and/or therapy plan (before services were provided). Date: __________________ [144A.4793, Subd. 3] Plan included the following items: ☐ ☐ ☐ ☐
Written statement of treatments and therapies to provide. [144A.4793, Subd. 3 (1)] Written instructions for each treatment or therapy. [144A.4793, Subd. 3 (2)] A list of the treatment or therapy tasks delegated to ULPs. [144A.4793, Subd. 3 (3)] Procedures to notify an RN or other LHP professional when problems arose with treatments or therapies. [144A.4793, Subd. 3 (4)] ☐ Client-specific instructions related to documentation of all treatments and/or therapies administered, or reason not administered, verified as administered and monitored to prevent complications or adverse reactions. [144A.4793, Subd. 3 (5)] ☐ Documentation of treatments and therapies was completed as required. [144A.4793, Subd. 5]
☐ Prescriber’s orders were written, complete and dated for treatments or therapies administered. [144A.4793, Subd. 6] Home Care and Assisted Living Program Health Regulation Division P.O. Box 3879 St. Paul, MN 55101-3879 Phone 651-201-5273 | Fax 651-215-9697 Home Care and Assisted Living (https://www.health.state.mn.us/facilities/regulation/homecare/index.html) To obtain this information in a different format, call 651-201-5273.
4
HCALP-F5022C 07/09/2019
Comprehensive Home Care Survey Self-Audit Tool
Topic: Employee Records Audited by:_____________________________ Date of Audit:___________________________ Task: Locate the following items: 1. Make five copies of this blank form 2. Retrieve five random employee records 3. Retrieve policies and procedures regarding employee records Review the items for compliance with the following requirements:
Requirement The home care provider maintains employee records and volunteer records. The employee record includes documentation of appropriate current professional licensure, registration, or certifications on file. The employee record includes documentation indicating: 1. Orientation (including all required topics) 2. Eight hours of annual training 3. Included in the eight hours of annual training is training in the areas of: a. Infection control b. Maltreatment of vulnerable adults c. Home care policies and procedures d. Home care bill of rights 4. Initial and annual dementia training (based upon position and duties)(may be included in the eight hours of annual training) 5. Competency evaluations are completed and signed by a RN (or therapist where appropriate) The employee record includes documentation of a current signed job description which includes: 1. Required qualifications 2. Job responsibilities 3. Identification of staff providing supervision The employee record includes documentation of annual performance reviews – including identification of areas where improvement or additional training is needed.
Met
Not N/A Met
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Employee Records Audit Tool Page 1 of 2
Requirement
Met
The employee record includes documentation of TB screening and dates. of screening. The employee record includes documentation of completed DHS background study.
Not N/A Met
If any applicable requirements are identified as “Not Met”, correct the situation, audit other employee records, forms, policies and procedures, and other sources of information to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. Hints: • •
See other audit tool forms for additional resources This audit tool only covers and pertains to what is required by the Comprehensive Home Care regulation. This audit tool does not cover and include any other requirements regarding employment including applications, I9’s, W4’s, employee handbooks, other company employment policies, etc.
References: MN144A.479 Subd. 7, MN144A.4796 Subd. 3, MN144A.4796 Subd. 7
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Employee Records Audit Tool Page 2 of 2
Comprehensive Home Care Survey Self-Audit Tool
Topic: Staff Orientation Audited by:_____________________________ Date of Audit:___________________________ Tasks: 1. Make five copies of this blank form 2. Retrieve five random employee personnel files 3. Locate a copy of the new employee orientation checklist Review the items for compliance with the following requirements:
Requirement Personnel files indicate that staff providing and supervising direct home care services successfully completed an orientation to comprehensive home care licensing requirements and regulations prior to providing home care services to clients. Such training is NOT transferable from another home care provider – it must be by your home care agency. The orientation documentation indicates that each of following topics was covered during orientation: An overview of Comprehensive Home Care Statutes (MN 144A.43 to 144A.4798). An introduction and review of all the provider's policies and procedures related to the provision of home care services. The handling of emergencies and use of emergency services. Training regarding the Minnesota Vulnerable Adults Act (reporting suspected maltreatment of vulnerable adults), including: 1. Status of home care staff as mandated reporters 2. Training regarding what constitutes suspected maltreatment, abuse, neglect, financial exploitation, unexplained physical injuries, accidents, and errors in the provision of therapeutic conduct. 3. Reporting internally 4. Immediate (not to exceed 24 hours) reporting to the Minnesota Adult Abuse Reporting Center (MAARC) A review of the Home Care Bill of Rights. Handling of clients' complaints, reporting of complaints, and where to report complaints including information on the Office of Health Facility Complaints and the Minnesota Adult Abuse Reporting Center (MAARC).
Met
Not N/A Met
X
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2015 Care Providers of Minnesota Staff Orientation Audit Tool Page 1 of 2
Requirement
Met
Not N/A Met
Consumer advocacy services of the Office of Ombudsman for Long-Term Care, Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care Ombudsman at the Department of Human Services, county managed care advocates, or other relevant advocacy services. A review of the types of home care services the employee will be providing and the provider's scope of licensure (hint – use the Home Care Disclosure Form used with clients – sample on MDH website). All direct care staff and supervisors working with those clients must receive training that includes a current explanation of Alzheimer's disease and related disorders, effective approaches to use to problem-solve when working with a client's challenging behaviors, and how to communicate with clients who have Alzheimer's or related disorders. If any applicable requirements are identified as “Not Met”, correct the situation, audit other personnel records to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. Hint: An orientation checklist that includes all the items noted above, in addition to any unique orientation topics you provide, signed and dated by the new employee and instructor(s) is one way to make sure all required topics are covered and documented. Reference: Comprehensive Home Care Statutes
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2015 Care Providers of Minnesota Staff Orientation Audit Tool Page 2 of 2
Comprehensive Home Care Survey Self-Audit Tool
Topic: Service Plans Audited by:_____________________________ Date of Audit:___________________________ Task: 1. Make five blank copies of this form 2. Retrieve five random service plans from your current client caseload Audit for compliance in the following areas.
Requirement Service plans are finalized within 14 days after the initiation of client services. Service plans and any revisions are signed by both the home care provider and by the client or client's representative. The service plans include information about how to contact the Office of Ombudsman for Long-Term Care. The service plan includes a description of the home care services provided to the client. The service plan includes the fees for home care services provided to the client. The service plan includes the frequency of each home care service provided to the client. The service plan includes the identification of the type or categories of staff for each home care provided to the client. The service plan includes the schedule and methods of ongoing monitoring and reassessments. The service plan includes the frequency of supervision of staff and who will be supervising staff. The service plan includes a description of any medication management services (if any) that are being provided to the client. The service plan includes a description of any prescribed treatments or therapies (if any) that are being provided to the client. The service plan includes a contingency plan that identifies the actions to be taken by the home care provider if scheduled home care services cannot be provided.
Met
Not N/A Met
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Service Plan Audit Tool Page 1 of 2
Requirement
Met
The service plan includes a contingency plan that identifies the actions to be taken by the client or client's representative if scheduled home care services cannot be provided. The service plan includes a contingency plan that includes information and methods for a home care client or client's representative to contact the home care provider. The service plan includes a contingency plan that includes names and contact information of persons the client wishes to have notified in an emergency or if there is a significant change in the client's condition. The service plan includes a contingency plan that includes identification and contact information of who has authority to sign for the client in an emergency. The service plan includes a contingency plan that includes identification of the circumstances in which emergency medical services are not to be summoned for the client, based on a client's completed advance directives, living will, and/or POLST forms. The service plan has been revised, based on client needs as identified in ongoing monitoring or reassessment visits. Services identified in the service plan are provided to the client as described in the service plan. No home care services are being provided to the client that are not listed on the current service plan. The service plan and the most recent revised service plan are included in the client record. Staff providing home care services to a client are informed of the current service plan for that client. Documentation indicates that the home care client was told in advance of any recommended changes by the provider to the service plan and the client was provided the opportunity to take an active part in any decisions about changes to the service plan.
Not N/A Met
If any applicable requirements are identified as “Not Met”, correct the situation, audit other service plans to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. References: 144A.44 Subd. 1 (04), 144A.4791 Subd. 9 (a)-(f), 144A.4792 Subd. 5 (a), 144A.4793 Subd. 3
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Service Plan Audit Tool Page 2 of 2
Tuberculosis Prevention and Control: Surveyor Checklist TEMPORARY LICENSED AND LICENSED HOME CARE PROVIDERS
Provider and Survey Information Provider name: __________________________________ HFID: __________________________________ Date/Time of survey: ___________________________ Surveyor: __________________________________
Resource for all items on checklist “Regulations for Tuberculosis Control in Minnesota Health Care Settings: A Guide for Implementing Tuberculosis (TB) Infection Control Regulations in Your Facility” (Relevant pages are noted below.) Regulations for Tuberculosis Control in Minnesota Health Care Settings (https://www.health.state.mn.us/diseases/tb/rules/tbregsmanual.pdf)
Verify the following items ☐ Provider had designated and documented a qualified person or team with primary responsibility for the TB infection control program. (Page 5) ☐ Provider had a current written TB risk assessment, reviewed and updated periodically. (Pages 5-6) Date of most recent risk assessment ____________________ ☐ Provider had a written infection control plan that included: • •
Procedures for handling persons with active TB disease; and Documentation of initial and ongoing TB-related training and education for all health care workers. (Pages 6-7)
Date of most recent review of plan ___________________ ☐ Results of baseline TB screening of all paid and unpaid health care workers were documented. All reports or copies of tuberculin skin tests (two-step TSTs), IGRAs/TB blood tests for M. tuberculosis, medical evaluation (if appropriate), TB history and symptom screen, and chest radiograph results were maintained in the health care worker’s employee file. (Pages 10-14) ☐ Baseline screening included two-step skin testing (unless the TB blood test was used). (Pages 10-11) ☐ If the setting was classified as “medium risk” or higher, results of serial TB screening of all paid and unpaid health care workers were documented. All reports or copies of tuberculin skin tests (TSTs), IGRAs/TB blood tests for M. tuberculosis, medical evaluation, TB symptom screen, and chest radiograph results were maintained in the health care worker’s employee file. (Page 11) Home Care and Assisted Living Program Health Regulation Division P.O. Box 3879 St. Paul, MN 55101 Phone 651-201-5273 | Fax 651-215-9697
https://www.health.state.mn.us/facilities/regulation/homecare/index.html To obtain this information in a different format, call: 651-201-5273. HCALP-F5051 04/30/2019
Regulations for Tuberculosis Control in Minnesota Health Care Settings A guide for implementing tuberculosis (TB) infection control regulations in your facility
Tuberculosis Prevention and Control Program PO Box 64975 St. Paul, MN 55164-0975 Phone: 651-201-5414 or 1-877-676-5414 www.health.state.mn.us/tb
July 2013
Table of Contents Introduction ..................................................................................................................... 1 Chapter 1. Background .................................................................................................. 3 Determining which regulations to follow ..........................................................................................................3
Chapter 2. TB Infection Control Program ................................................................... 5 TB infection control team..................................................................................................................................5 Facility TB risk assessment ..............................................................................................................................5 Written TB infection control procedures ...........................................................................................................6 HCW education .................................................................................................................................................7
Chapter 3. Screening Health Care Workers (HCWs).................................................. 9 Definition of a HCW .........................................................................................................................................9 General principles............................................................................................................................................10 Baseline TB screening .....................................................................................................................................10 Serial TB screening .........................................................................................................................................11 Special situations HCW with signs or symptoms of active TB disease.................................................................................11 HCW with a newly-identified positive TST or IGRA...............................................................................12 HCW with written documentation of a previous positive TST or IGRA..................................................13 HCW with verbal (undocumented) history of a previous positive TST or IGRA ....................................13 Pregnant HCW ..........................................................................................................................................13 Conversions ..............................................................................................................................................13 HCW with TST results between 5 and 9 mm of induration......................................................................14 Students .....................................................................................................................................................14 Volunteers .................................................................................................................................................14 HCW with previous history of severe adverse reaction to TST ...............................................................14 HCW refusal .............................................................................................................................................14 HCW who travels outside of the United States ........................................................................................15 Baseline TB Screening Tool for HCWs ..........................................................................................................16 Serial TB Screening Tool for HCWs ...............................................................................................................18 Exemption Form for Tuberculin Skin Testing of a Pregnant HCW ................................................................20 Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm .........21
Chapter 4. Screening Residents ................................................................................... 23 General principles............................................................................................................................................23 Baseline TB screening of residents in boarding care homes and nursing homes............................................23 Baseline TB screening of residents in residential hospices .............................................................................24 Special situations Resident with newly identified positive TST or IGRA .............................................................................24 Resident with written documentation of previous positive TST or IGRA................................................24 Resident with verbal (undocumented) history of previous positive TST or IGRA .................................25 Residents with signs or symptoms of active TB disease ..........................................................................25 Residents with previous history of severe adverse reaction to TST .........................................................26 Resident refusal.........................................................................................................................................26 Baseline TB Screening Tool for Nursing Home and Boarding Care Home Residents ...................................27 Baseline TB Screening Tool for Residents in Residential Hospice.................................................................29
Glossary ......................................................................................................................... 31
Introduction The purpose of this manual is to assist health care facilities in Minnesota to understand what is needed to be in compliance with Minnesota laws revised in 2013 regarding TB prevention and control, and to provide tools for implementing legal regulations and best practices in their settings. Minnesota laws governing tuberculosis (TB) prevention and control regulations in health care settings (including TB screening of health care workers and residents) have historically consisted of a variety of separate rules written for specific settings at various times. Many of them were based on national recommendations published in the 1990s or earlier. In 2005, the U.S. Centers for Disease Control and Prevention (CDC) published revised guidelines* (www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm). Since that time, the Minnesota Department of Health (MDH) has recognized that legal regulations and best practices for TB infection control in Minnesota needed to be revised to meet these guidelines and to incorporate current knowledge and technology. The “TB waivers,” issued by MDH on March 9, 2009, were an interim step in this process to address the outdated TB laws for boarding care homes, home care providers, nursing homes, and supervised living facilities. The “TB waivers” stated that licensees were required to follow the 2005 CDC guidelines. As a final step, MDH proposed new legislation in 2013, which was adopted by the Minnesota Legislature and takes effect on August 1, 2013. These laws are based on the 2005 national guidelines and replace the 2009 “TB waivers.” They apply to settings licensed by MDH, including boarding care homes, home care providers, hospices, nursing homes, outpatient surgical centers, and supervised living facilities. *Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 2005. From CDC, MMWR, December 30, 2005, 54(RR17);1-141.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 1
Chapter 1 Background Determining which regulations to follow All state-licensed or federally-certified health care settings in Minnesota are required by law to follow certain measures to prevent and control TB in their facilities. In addition, facilities should follow the regulations of the Minnesota Occupational Safety and Health Administration (MN-OSHA). (see Resources) There are three categories of regulations related to TB: 1. TB infection control program 2. Process for screening health care workers (HCWs) 3. Process for screening residents This manual provides specific information about each type of regulation. To determine which of these regulations apply to your facility, see the table below. If you are unsure what type of license your facility has, you can look it up at www.health.state.mn.us/divs/fpc/directory/providerselect.cfm. TB infection control program (Chapter 2) Yes
Yes
Screening residents (Chapter 4) No
Boarding care home (MDH licensed) Home care provider (MDH licensed)
Yes
Yes
Yes
Yes
Yes
No
Hospice (MDH licensed)
Yes
Yes
Yes (residential hospice only)
Nursing home (MDH licensed)
Yes
Yes
Yes
Outpatient surgical center (MDH licensed)
Yes
Yes
No
Health care setting Assisted living facility
Screening HCWs (Chapter 3)
Regulations for Tuberculosis Control in Minnesota Health Care Settings
Regulatory authority Minnesota Statutes, section 144A.4798, Subd. 11 Minnesota Statutes, section 144.56, Subd. 2c2 Minnesota Statutes, section 144A.4798, Subd. 11 Minnesota Statutes, section 144A.753, Subd.43 Minnesota Statutes, section 144A.04, Subd. 3b4 Minnesota Statutes, section 144.55, Subd. 3c5
July 2013 • Page 3
Background Health care setting Supervised living facility (MDH licensed) Supplemental nursing services agency (MDH licensed) All other settings
TB infection control program (Chapter 2) Yes
Chapter 1 Screening HCWs (Chapter 3) Yes
Screening residents (Chapter 4) No
Education program only
Yes
No
Yes
Yes
No
1
www.revisor.mn.gov/statutes/?id=144A.4798
2
www.revisor.mn.gov/statutes/?id=144.56
3
www.revisor.mn.gov/statutes/?id=144A.753
4
www.revisor.mn.gov/statutes/?id=144A.04
5
www.revisor.mn.gov/statutes/?id=144.55
6
www.revisor.mn.gov/statutes/?id=144.50
7
www.revisor.mn.gov/statutes/?id=144A.72
8
www.dli.mn.gov/OSHA/PDF/tuberculosis_cpl.pdf
Page 4 • July 2013
Regulatory authority Minnesota Statutes, section 144.50, Subd. 6a6 Minnesota Statutes, section 144A.72, Subd. 17 MN-OSHA8
Regulations for Tuberculosis Control in Minnesota Health Care Settings
Chapter 2 TB Infection Control Program All health care settings in Minnesota should have an up-to-date TB infection control program that includes: • • • •
A team responsible for TB infection control A facility TB risk assessment Written TB infection control procedures Health care worker (HCW) education
TB infection control team Identify a qualified person or a team of persons in your facility and assign them primary responsibility and authority for TB infection control. This person or team will conduct your setting’s facility TB risk assessment; develop, implement, and enforce TB infection control policies (including HCW and resident TB screening); and ensure that HCWs receive adequate TB-related training and education.
Facility TB risk assessment The facility TB risk assessment is a structured evaluation of a health care facility or setting’s risk for transmission of M. tuberculosis. The infection control team determines the setting’s TB risk classification based on the results of the facility TB risk assessment. All health care settings in Minnesota should perform an initial facility TB risk assessment. Medium-risk settings should update their assessment yearly; low-risk settings should update theirs every other year. Keep your facility’s completed TB risk assessment worksheets on file for future reference. Your facility TB risk assessment should be conducted by your infection control team. In general, oneassessment encompasses an entire setting. However, in certain settings it may be appropriate to do separate assessments for specific areas within the setting. Information on the number of TB cases by county for the previous year are posted on MDH’s web site in May of each year. Risk assessments conducted early in the calendar year (before new data are posted) should use data from the previous year. Please do not contact MDH before May to obtain TB data for the previous year. Choose one of the following three methods to conduct your risk assessment(s): 1. Use the Facility TB Risk Assessment Worksheet for Health Care Settings Licensed by the Minnesota Department of Health (MDH). This worksheet was developed by MDH and can be used by boarding care homes, home care providers, hospices, nursing homes, outpatient surgical centers, and supervised living facilities (see www.health.state.mn.us/divs/idepc/diseases/tb/rules/index. html#ch2). 2. Use the Appendix B: Tuberculosis (TB) risk assessment worksheet from the Centers for Disease Control and Prevention (CDC). (see www.health.state.mn.us/divs/idepc/diseases/tb/rules/index. html#ch2). 3. Create your own assessment tool using the criteria listed on pages 9-12 of CDC’s “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.” Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 5
TB Infection Control Program
Chapter 2
Use the results from your facility TB risk assessment to determine your TB risk classification. The three risk classifications are: • Low risk, in which persons with active TB disease are not expected to be encountered and exposure to TB is unlikely. • Medium risk, in which HCWs will or might be exposed to persons with active TB disease or clinical specimens that might contain M. tuberculosis. • Potential ongoing transmission, in which there is evidence of person-to-person transmission of M. tuberculosis. This is a temporary classification. If you determine that this classification applies to your setting, please consult with MDH’s TB Prevention and Control Program at 651-201-5414 for guidance. If the infection control team is unsure whether to classify your setting as low or medium risk, the medium risk classification should be used. When updating your facility TB risk assessment, you should confirm and document actions that were taken to address any problems identified during the previous risk assessment. In addition, you should conduct a problem evaluation to address any situations that may have occurred since your last risk assessment was done. Examples might include: • A person with suspected or confirmed active TB disease was not promptly recognized and appropriate airborne precautions were not initiated, • Certain administrative, environmental, or respiratory-protection controls failed, and • Infection control lapses were identified (for example, HCWs were not adequately screened for TB; baseline TB screening of residents [if applicable] was not consistently done and documented; there were delays in transferring of patients with symptoms of active TB disease; or TB-related education and training of HCWs was not done or needs to be updated).
Written TB infection control procedures Each facility should have written procedures to address TB infection control. Medium-risk settings should review their procedures annually and update, if necessary. Low-risk settings should review their procedures every other year and update, if necessary. Procedures should address: • Early recognition: All HCWs should know the signs and symptoms of TB and their role in their facility’s TB infection control program. • Isolation: Place a potentially infectious TB patient in an airborne infection isolation (AII) room if available; If not, place patient in separate room with door shut. • Referral: If your setting does not handle TB patients, transfer potentially infections TB patients to a setting that is equipped to evaluate and treat TB patients. The procedures should include information about working with the local or state public health department to conduct a TB contact investigation if health care-associated transmission of M. tuberculosis is suspected.
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Regulations for Tuberculosis Control in Minnesota Health Care Settings
TB Infection Control Program
Chapter 2
In addition, settings that expect to encounter (admit) patients with suspected or confirmed active TB disease are required to: • Implement and maintain environmental controls, including AII rooms, • Develop a respiratory protection program, and • Develop a plan for accepting patients with suspected or confirmed active TB disease.
HCW education TB training is required at time of hire for all HCWs. The content of the training should be appropriate to the job responsibilities and educational or professional background of the HCW. In medium-risk settings, TB training should be conducted annually. Low-risk settings should annually evaluate the need for TB training, and conduct training as needed. Content should focus on basic information about: • TB pathogenesis and transmission, • Signs and symptoms of active TB disease, and • Your health care setting’s infection control plan (i.e., how to implement your early recognition, isolation, and referral procedure), especially any sections that employees are responsible for implementing.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 7
Chapter 3 Screening Health Care Workers (HCWs) Definition of a HCW: For purposes of TB infection control procedures, the following staff should be considered HCWs and should be included in your TB screening program: • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Administrators and managers Bronchoscopy Chaplains Clerical Computer programmers Construction Correctional officers Dental Dietician or dietary Educators Engineers Food service Health aides Health and safety Housekeeping or custodial Homeless shelter Infection control Janitorial, maintenance Laboratory Morgue Nurses Outreach Patient transport staff, including EMS Pharmacists Phlebotomists Physical and occupational therapists Physicians and other clinicians Public safety Radiology Respiratory therapists Social workers Students (e.g., medical, nursing, technicians, and allied health) Technicians (e.g., health, laboratory, radiology, and animal) Volunteers
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 9
Screening Health Care Workers (HCWs)
Chapter 3
In addition, HCWs who perform any of the following activities should also be included in your TB screening program: • Entering patient rooms or treatment rooms whether or not a patient is present, • Participating in aerosol-generating or aerosol-producing procedures (e.g., bronchoscopy, sputum induction, and administration of aerosolized medications), • Participating in suspected or confirmed M. tuberculosis specimen processing, or • Installing, maintaining, or replacing environmental controls in areas in which persons with active TB disease are encountered.
General principles • There are two methods available to screen for TB infection: the tuberculin skin test (TST) and the Interferon Gamma Release Assay (IGRA). Information about these methods is available at www.health.state.mn.us/divs/idepc/diseases/tb/tst.html and www.health.state.mn.us/divs/idepc/ diseases/tb/bloodtests.html. • All reports or copies of TST or IGRA results and any related chest X-ray and medical evaluations should be maintained in the employee’s record. • TST documentation should include the date of the test (i.e., month, day, year), the number of millimeters of induration (if no induration, document “0” mm) and interpretation (i.e., positive or negative). • IGRA documentation should include the date of the test (i.e., month, day, year), the qualitative results (i.e., positive, negative, indeterminate or borderline) and the quantitative assay (i.e., Nil, TB and Mitogen concentrations or spot counts). Indeterminate or borderline results indicate an uncertain likelihood of M. tuberculosis infection and should be further evaluated by a physician. • HCWs should be encouraged to keep copies of the results of their TB screening for future use. • Disregard a HCW’s history of BCG vaccination when administering and interpreting a TST. • It is the responsibility of the infection control team to ensure that written procedures are in place and are followed by staff to ensure that employees are free of infectious TB disease before beginning employment. Questions regarding the significance of an individual’s medical test results (e.g., chest X-ray reports) should be referred to the appropriate medical or nursing staff in your facility.
Baseline TB screening Baseline TB screening is required for all HCWs (Table 3.1). Baseline TB screening consists of three components: 1. Assessing for current symptoms of active TB disease, 2. Assessing TB history, and 3. Testing for the presence of infection with Mycobacterium tuberculosis by administering either a two-step TST or single IGRA.
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Regulations for Tuberculosis Control in Minnesota Health Care Settings
Screening Health Care Workers (HCWs)
Chapter 3
An employee may begin working with patients after a negative TB symptom screen (i.e., no symptoms of active TB disease) and a negative IGRA or TST (i.e., first step) dated within 90 days before hire. The second TST may be performed after the HCW starts working with patients. Available tool: Baseline TB Screening Tool for HCWs Template on pages 16-17.
Serial TB screening Serial TB screening refers to TB screening performed at regular intervals following baseline TB screening. The frequency of serial TB testing is based on your facility’s TB risk classification (Table 3.1). Serial TB screening consists of three components: 1. Assessing for current symptoms of active TB disease, 2. Assessing TB history, and 3. Testing for the presence of infection with Mycobacterium tuberculosis by administering either a onestep TST or single IGRA. HCWs who have positive TSTs or IGRAs and who work in medium-risk settings do not need additional TSTs or IGRAs but should be assessed for current TB symptoms on an annual basis and instructed to seek medical evaluation if TB symptoms develop at any time. Available tool: Serial TB Screening Tool for HCWs Template on pages 18-19.
Table 3.1: Baseline and serial TB screening regulations for HCWs Risk classification Low Medium Potential ongoing transmission (usually temporary)
Baseline screening Required Required Required
Serial screening Not required Annual May require testing on a quarterly or twice-yearly basis. Consult with the MDH TB Prevention and Control Program at 651-201-5414 regarding the frequency of testing under these circumstances.
Special Situations HCW with signs or symptoms of active TB disease A HCW with infectious TB disease poses a special risk in the workplace because of the potential to spread the infection to vulnerable patients. TB is not commonly found in Minnesota HCWs, but it does occur. In 2011-2012, a total of 12 HCWs in Minnesota were diagnosed with active TB disease. Do not wait for the results of a TST or IGRA before referring a person with TB symptoms for a medical evaluation. Approximately 25 percent of persons with active TB disease have a negative TST or IGRA because the body’s immune system is not strong enough to respond to the test.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 11
Screening Health Care Workers (HCWs)
Chapter 3
Persons with active TB disease may have one or more of the following symptoms: • • • • • • • • •
Prolonged cough (≥ three weeks ) Hemoptysis Weight loss Night sweats Fatigue Fever, chills Poor appetite Chest pain Other symptoms may be present, depending on the site of disease
Active TB disease most commonly affects the lungs (pulmonary). However, TB disease can occur in other parts of the body (most commonly, pleural or lymphatic). Any HCW with symptoms of active TB disease, regardless of the results of the TST or IGRA, should be promptly evaluated to exclude a diagnosis of active TB disease. This should include a medical evaluation, a chest X-ray, and collection of sputum specimens for mycobacterial smear and culture or additional testing if indicated. If active TB disease is confirmed or suspected, the diagnosing clinician should notify MDH at 651-201-5414 within one working day. HCWs with suspected or confirmed infectious TB disease or a draining TB skin lesion should be excluded from the workplace. They should be allowed to return to work only after a physicianknowledgeable and experienced in managing TB has determined that they are no longer infectious (this may be done in consultation with the health department). HCWs with extrapulmonary TB disease usually do not need to be excluded from the workplace as long as the respiratory tract is not involved and the HCW has been cleared for work by a physician.
HCW with a newly-identified positive TST or IGRA Before the HCW has direct patient contact, the following should be documented in their record: 1. Test result, 2. Assessment for current TB symptoms, 3. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the HCW has not been exposed to infectious TB disease since the chest X-ray was done, and 4. Medical evaluation to rule out a diagnosis of infectious TB disease. After the negative baseline chest X-ray is done and the results are documented, additional chest X-rays are not needed unless the HCW develops symptoms of active TB disease or a clinician recommends a repeat chest X-ray. HCWs who work in medium-risk settings should be assessed for current TB symptoms on an annual basis and instructed to seek medical evaluation if TB symptoms develop at any time.
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Regulations for Tuberculosis Control in Minnesota Health Care Settings
Screening Health Care Workers (HCWs)
Chapter 3
HCW with written documentation of a previous positive TST or IGRA If the test is appropriately documented you do not need to repeat the test. Before the HCW has direct patient contact, the following should be documented in their record: 1. Test result, 2. Assessment for current TB symptoms, 3. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the HCW has not been exposed to infectious TB disease since the chest X-ray was done. If infectious TB disease is ruled out, additional chest X-rays are not needed unless the HCW develops symptoms of active TB disease or a clinician recommends a repeat chest X-ray, and 4. If the chest X-ray is done at the time of hire because documentation of a previous film was not available, a medical evaluation to rule out infectious TB disease should be done. No medical evaluation is required if HCW already has a chest X-ray dated after documented positive TST or IGRA. HCWs who work in medium-risk settings should be assessed for current TB symptoms on an annual basis and instructed to seek medical evaluation if TB symptoms develop at any time.
HCW with a verbal (undocumented) history of a previous positive TST or IGRA These HCWs should undergo the same screening procedures as HCWs without previous positive results. Results of the screening should be documented in the HCW’s record. If the HCW has documentation of previous treatment for latent TB infection or active TB disease, that documentation may be substituted for documentation of previous positive TST or IGRA results.
Pregnant HCW Pregnancy is not a contraindication for TB testing. Pregnant women should be included in the same baseline and serial TB screening programs as other HCWs. If a pregnant HCW declines a TST, offer an IGRA if it is available. If an IGRA is not available, consider having the HCW and her personal health care provider complete the Exemption Form for Tuberculin Skin Testing of a Pregnant HCW (see page 20). A pregnant HCW with a newly identified positive TST or IGRA, or signs and symptoms of active TB disease, is at increased risk for active TB disease and should receive a chest X-ray, using an abdominal shield.
Conversions A conversion is when a person’s TST or IGRA result is initially negative but changes to positive at a later date. For surveillance purposes, an increase in induration of >10 mm is defined as a TST conversion. Follow instructions for a HCW with newly positive TST or IGRA. Additional information is available on pages 13 and 32-34 of “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.” Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 13
Screening Health Care Workers (HCWs)
Chapter 3
HCW with TST results between 5 and 9 mm of induration This result is considered negative for most HCWs but is positive for persons with certain risk factors, including: • • • •
HIV positive, Recent close contact with someone with infectious TB disease, Organ transplant recipient, Immunosuppressed due to taking immunosuppressive drugs (equivalent to greater than 15 mg of prednisone a day for one month or longer) or TNF alpha inhibitor drugs such as Enbrel®, Humira®, or Remicade® for treatment of rheumatoid arthritis, Crohn’s disease, or other autoimmune disorders, or • Have a current chest X-ray that shows “scarring” or “fibrosis” or “old, healed TB.” Because employers cannot legally collect information about these personal health TB risk factors, it is recommended, but not required, that these HCWs be given MDH’s Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm (see page 21) and encouraged to follow-up with their personal health care providers as necessary.
Students Students who will be performing health care-related activities should receive the same screening as paid HCWs. Health care facilities where students are placed should ensure that the students’ school has performed the required testing. Students who will be in the clinical setting for less than two weeks require only a one-step (not the two-step) TST.
Volunteers Volunteers who share airspace with patients for five to 10 hours or more per week should receive the same TB screening as paid HCWs.
HCW with previous history of severe adverse reaction to TST Severe adverse reactions (i.e., necrosis, blistering, anaphylactic shock or ulceration) to TSTs are rare events. A HCW who provides a convincing verbal report of a severe adverse reaction to a prior TST, even if the reaction is not documented, should NOT receive a TST. Substitute an IGRA for the TST if it is available. If an IGRA is not available, document the severe reaction, conduct the TB symptom screen and review TB risk factors.
HCW refusal HCWs who refuse a TST should be screened using an IGRA. HCWs who refuse an IGRA should be screened using a TST. HCWs who refuse both the TST and IGRA should receive a chest X-ray to rule out infectious TB disease.
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Regulations for Tuberculosis Control in Minnesota Health Care Settings
Screening Health Care Workers (HCWs)
Chapter 3
HCW who travels outside of the United States It is recommended, but not required, that HCWs who travel for more than four weeks to a country where TB is common and have close contact with residents of that country (e.g., visiting family, medical volunteer work) be tested with a single TST or IGRA eight to 10 weeks after returning to the United States. The CDC Health Information for International Travel (commonly called the Yellow Book) can provide more information. You can find it at: wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/tuberculosis.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 15
Chapter 3 Baseline TB Screening Tool for HCWs Template (page 1)
Baseline TB Screening Tool for Health Care Workers (HCWs) ______________________________________ Last name, first name, middle initial
____/____/______ Date form completed
____/____/_____ Date of birth
(______)____________ Work phone number
Baseline TB screening includes three components: (1) Assessing for current symptoms of active TB disease *and* (2) Assessing HCW’s history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a two-step TST.
Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)
Chest pain
Fatigue
Night sweats
Coughing up blood
Weight loss/poor appetite
Fever/chills
Note: If TB symptoms are present, promptly refer HCW for a chest X-ray and medical evaluation before starting work. Do not wait for the TST or TB blood test result.
HCW’s history (circle response) Have you ever had a positive reaction to a TB skin test or TB blood test? Yes No If yes: Date______________ Number of millimeters of induration ______ Have you had a TB skin test in the past 12 months? Yes No If yes: Date______________ Number of millimeters of induration ______ Result ______________ Comments Have you ever had the BCG vaccine?
Yes
No
Have you ever been treated for latent TB infection?
Yes
No
Have you ever been treated for active TB disease?
Yes
No
Have you ever had an adverse reaction to a TB skin test?
Yes
No
Have you received a live-virus vaccine within the past 6 weeks?
Yes
No
Tool address: Page 16 • July 2013
www.health.state.mn.us/divs/idepc/diseases/tb/rules/basetbscrn.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings
Chapter 3 Baseline TB Screening Tool for HCWs Template (page 2) TB Blood Test Name of TB blood test (circle)
QuantiFERON TB-Gold
QuantiFERON-TB-Gold InTube
T-SPOT
Date of blood draw Results Interpretation of reading (circle)
Positive* Negative
Indeterminate
Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease
Tuberculin skin testing (TST) TST – First Step
TST – Second Step
Administration Name of person administering test Date and time administered Location (circle)
L forearm R forearm Other:________ L forearm R forearm Other:________
Tuberculin manufacturer Tuberculin expiration date and lot # Signature of person who administered test Results (read between 48-72 hours) Date and time read: Number of mm of induration: (across forearm)
____mm
____mm
Interpretation of reading* (circle)
Positive** Negative***
Positive** Negative
Reader’s signature *Consult grid at www.health.state.mn.us/divs/idepc/diseases/tb/candidates.pdf ** Refer HCW for a chest x-ray to rule out active TB disease *** If results are negative, perform the second step in one to three weeks
Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center
Tool address:
www.health.state.mn.us/divs/idepc/diseases/tb/rules/basetbscrn.doc
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 17
Chapter 3 Serial TB Screening Tool for HCWs Template (page 1)
Serial TB Screening Tool for Health Care Workers (HCWs) ______________________________________ Last name, first name, middle initial
____/____/______ Date form completed
____/____/_____ Date of birth
(______)____________ Work phone number
Serial TB screening includes three components: (1) Assessing for current symptoms of active TB disease *and* (2) Assessing HCW’s history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a single TST.
Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)
Chest pain
Night sweats
Coughing up blood
Weight loss/poor appetite
Fever/chills
Fatigue
Note: If TB symptoms are present, promptly refer HCW for a chest X-ray and medical evaluation before starting work. Do not wait for the TST or TB blood test result.
HCW’s history (circle response) Have you ever had a positive reaction to a TB skin test or TB blood test? Yes No If yes: Date______________ Number of millimeters of induration ______ Have you had a TB skin test in the past 12 months? Yes No If yes: Date______________ Number of millimeters of induration ______ Result ______________
Comments Have you ever had the BCG vaccine?
Yes
No
Have you ever been treated for latent TB infection?
Yes
No
Have you ever been treated for active TB disease?
Yes
No
Have you ever had an adverse reaction to a TB skin test?
Yes
No
Have you received a live-virus vaccine within the past 6 weeks?
Yes
No
Tool address: Page 18 • July 2013
www.health.state.mn.us/divs/idepc/diseases/tb/rules/sertbscrn.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings
Chapter 3 Serial TB Screening Tool for HCWs Template (page 2) TB Blood Test Name of TB blood test (circle)
QuantiFERON TB-Gold
QuantiFERON-TB-Gold InTube
T-SPOT
Date of blood draw Results Interpretation of reading (circle)
Positive*
Negative
Indeterminate
Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease
Tuberculin Skin Testing (TST) Administration Name of person administering test Date and time administered Location (circle)
L forearm R forearm Other:________
Tuberculin manufacturer Tuberculin expiration date and lot # Signature of person who administered test Results (read between 48-72 hours) Date and time read: Number of mm of induration: (across forearm)
____mm
Interpretation of reading* (circle)
Positive** Negative
Reader’s signature *Consult grid at www.health.state.mn.us/divs/idepc/diseases/tb/candidates.pdf ** Refer HCW for a chest x-ray to rule out active TB disease
Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center
Tool address:
www.health.state.mn.us/divs/idepc/diseases/tb/rules/sertbscrn.doc
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 19
Chapter 3 Exemption Form for Tuberculin Skin Testing of a Pregnant HCW Note: This is a suggested template developed by the Minnesota Department of Health (MDH) Tuberculosis Prevention and Control Program. It is designed to assist health care facilities who receive employee requests to be exempted from TB skin testing due to pregnancy. This is not an official MDH form. It may be adapted by individual health care facilities to create their own form. MDH does not recommend the practice of routinely exempting health care workers from TB skin testing due to pregnancy.
To remove “Sample” watermark: On the “Format” menu, click on “Background,” then click “Printed Watermark,” then click “No watermark.”
Exemption from Tuberculin Skin Testing for a Pregnant Health Care Worker I, _________ (physician’s name) recommend that my patient, ______, be exempted from tuberculin skin testing (TST) for the following reason: ______. I understand that the U.S. Centers for Disease Control and Prevention and the Minnesota Department of Health consider TST to be valid and safe during pregnancy and recommend that pregnant women with risk factors (e.g., health care workers) for exposure to tuberculosis (TB) should receive testing. Check one: ____I will arrange for my patient to receive a TB blood test (i.e., QuantiFERON, T-Spot) as a substitute for TST. ____I have been unable to locate a laboratory that will perform a TB blood test (i.e., QuantiFERON, T-Spot) for my patient. Signature: _________ (physician) Clinic name and phone number: _____________ I ___ (employee) have read the above information and understand that tuberculin skin testing is generally considered safe in pregnant women. Signature: _________ (employee) References: 1. American Thoracic Society, U.S. Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent TB infection. MMWR 2000: 49(No. RR-6) 2. CDC fact sheet. Tuberculosis and Pregnancy (2008)
Tool address: Page 20 • July 2013
www.health.state.mn.us/divs/idepc/diseases/tb/rules/exmtpreghcw.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings
Chapter 3 Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm Information for Health Care Workers with Tuberculin Skin Test (TST) Results between 5 and 9 mm Note: This is a suggested template developed by the Minnesota Department of Health (MDH) Tuberculosis (TB) Prevention and Control Program. It is designed to assist health care facilities who have employees with tuberculin skin test (TST) results between 5 and 9 mm induration. TST results between 5 and 9 mm of induration are negative for most health care workers but are positive for those with certain risk factors. The purpose of this form is to educate health care workers who have TST results between 5 and 9 mm and may have these risk factors. Employers cannot and should not collect information about these personal health TB risk factors. Employers are not required to follow-up with employees who have TST results between 5 and 9 mm unless the employee also has signs or symptoms of active TB disease. This is not an official MDH form. It may be adapted by individual health care facilities to create their own form. To remove “Sample” watermark: On the “Format” menu, click on “Background,” then click “Printed Watermark,” then click “No Watermark.”
SAMPLE Dear employee: You recently participated in tuberculin skin testing (TST). This is a test for latent tuberculosis (TB) infection. Your TST result, administered on ___/___/______ and read on ___/___/_____ was _____ mm induration. This test result is considered “negative” (normal) for most health care workers, but is considered “positive” for people with the following risk factors: x Are HIV positive x Have had recent close contact with someone with active TB disease of the lungs x Have had an organ transplant x Are immunosuppressed due to taking immunosuppressive drugs (equivalent to greater than 15 mg of prednisone a day for 1 month or longer) or TNF alpha inhibitor drugs such as Enbrel®, Humira®, or Remicade® for treatment of rheumatoid arthritis, Crohn’s disease, or other autoimmune disorders x Have a current chest X-ray that shows “scarring” or “fibrosis” or “old, healed TB” If you have one or more of these risk factors, we strongly encourage you to set up an appointment with your personal health care provider to discuss your test results. We recommend that you bring this form with you to your medical appointment.
Additional information about TB testing and latent TB infection is available at www.health.state.mn.us/divs/idepc/diseases/tb/factsheets/tst.html.
Tool address:
www.health.state.mn.us/divs/idepc/diseases/tb/rules/hcwtstrslt.doc
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 21
Chapter 4 Screening Residents Routine TB screening of residents (patients) is not required in Minnesota health care settings except for boarding care homes, nursing homes, and residential hospices. Residents in other facilities may be screened for TB at the discretion of their health care providers or the health care setting’s infection control team.
General principles • Screening should be initiated within 72 hours of admission or within 90 days prior to admission. • There are two methods available to screen for TB infection: the tuberculin skin test (TST) and the Interferon Gamma Release Assay (IGRA). Information about these methods is available at www.health.state.mn.us/divs/idepc/diseases/tb/tst.html and www.health.state.mn.us/divs/idepc/ diseases/tb/bloodtests.html. • It is the responsibility of the infection control team to ensure that written procedures are in place and are followed by staff to ensure that residents are free of infectious TB disease at time of admission. Questions regarding the significance of an individual’s medical test results (e.g., chest X-ray reports) should be referred to the appropriate medical or nursing staff in your facility. • All reports or copies of the TST or IGRA and any chest X-rays and medical evaluations conducted should be maintained in the resident’s medical record. • Residents who are temporarily transferred to other facilities (e.g., a hospital) do not need to be re-tested upon re-admission if that facility has a TB prevention and control program in place. • Disregard a resident’s history of BCG vaccination when administering and interpreting a TST. • TST documentation for residents should include the date (i.e., month, day, year), the number of millimeters of induration (if no induration, document “0” mm), and interpretation (i.e., positive or negative). If this information is not available, documentation of a history of infection with TB (e.g., a previous positive skin test or history of active TB disease) by a physician in the resident’s medical record is acceptable. • IGRA documentation should include the date of the test (i.e., month, day, year), the qualitative results (i.e., positive, negative, indeterminate, or borderline) and the quantitative assay (i.e., Nil, TB and Mitogen concentrations or spot counts). Indeterminate or borderline results indicate an uncertain likelihood of M. tuberculosis infection and should be further evaluated by a physician.
Baseline TB screening of residents in boarding care homes and nursing homes Baseline TB screening consists of three components: 1. Assessing for current symptoms of active TB disease, 2. Assessing for TB risk factors and TB history, and 3. Testing for the presence of infection with Mycobacterium tuberculosis by administering either a two-step TST or single IGRA. Available tool: Baseline TB Screening Tool for Residents Template on pages 27-28.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 23
Screening Residents
Chapter 4
Baseline TB screening of residents in residential hospices Baseline TB screening consists of one component: 1. Assessing for current symptoms of active TB disease. Screening for the presence of infection with Mycobacterium tuberculosis using a TST or IGRA is not necessary. Available tool: Baseline TB Screening Tool for Residents in Residential Hospice Template on page 29.
Special Situations Resident with a newly identified positive TST or IGRA Documentation should include: 1. Test result, 2. Assessment for current TB symptoms, 3. Assessment of risk factors for progression to active TB disease, 4. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the resident has not been exposed to infectious TB disease since the chest X-ray was done. After a baseline chest X-ray is performed and infectious TB disease has been ruled out, the resident will not need additional chest X-rays unless they develop symptoms of active TB disease or a clinician recommends a repeat chest X-ray, and 5. Medical evaluation to rule out a diagnosis of infectious TB disease. Post the resident’s positive TST or IGRA status in a prominent place in their record to ensure that staff are aware of it in case the resident develops symptoms of active TB disease at a later date.
Resident with written documentation of a previous positive TST or IGRA If the result is appropriately documented, an additional TST or IGRA is not needed. Documentation should include: 1. Test result, 2. Assessment for current TB symptoms, 3. Assessment of risk factors for progression to active TB disease, 4. Chest X-ray to rule out infectious TB disease. The chest X-ray should be done after the date of the positive TST or IGRA; however, a chest X-ray done within the three months prior to the TST/IGRA is acceptable, provided that the resident has not been exposed to infectious TB disease since the chest X-ray was done. After a baseline chest X-ray is performed and infectious TB disease has been ruled out, the resident will not need additional chest X-rays unless they develop symptoms of active TB disease or a clinician recommends a repeat chest X-ray, and 5. Medical evaluation to rule out a diagnosis of infectious TB disease if resident didn’t have an appropriately documented chest X-ray and needed to get one. No medical evaluation is required if resident already has a chest X-ray dated after the documented positive TST or IGRA.
Page 24 • July 2013
Regulations for Tuberculosis Control in Minnesota Health Care Settings
Screening Residents
Chapter 4
Post the resident’s positive TST or IGRA status in a prominent place in their record to ensure that staff are aware of it in case the resident develops symptoms of active TB disease at a later date.
Resident with a verbal (undocumented) history of a previous positive TST or IGRA These residents should undergo the same screening process as residents without previous positive results. Results of the screening should be documented in the resident’s record. If the resident has documentation of previous treatment for latent TB infection or active TB disease, that documentation may be substituted for documentation of previous positive TST or IGRA results.
Resident with signs or symptoms of active TB disease Do not wait for the results of a TST or IGRA before referring a resident with TB symptoms for a medical evaluation. Approximately 25 percent of persons with active TB disease have a negative TST or IGRA because the body’s immune system is not strong enough to respond to the test. Residents with active TB disease may have one or more of the following: • • • • • • • • •
Prolonged cough (≥ three weeks ) Hemoptysis Weight loss Night sweats Fatigue Fever, chills Poor appetite Chest pain Other symptoms may be present, depending on the site of disease
Active TB disease most commonly affects the lungs (pulmonary), but approximately 40 percent of TB cases in Minnesota involve only an extrapulmonary site of disease (most commonly pleural or lymphatic). For infection control purposes, only pulmonary, pleural and laryngeal TB disease are considered potentially infectious; most extrapulmonary TB cannot be transmitted to others. Any resident with symptoms of infectious TB disease, regardless of the results of the TST or IGRA, should be transferred to a facility with respiratory isolation rooms and promptly evaluated to exclude a diagnosis of active TB disease. This should include a medical evaluation and symptom screen, a chest X-ray, and collection of sputum specimens or additional testing if indicated. If active TB disease is confirmed or suspected, the diagnosing clinician should notify MDH at 651-2015414 within one working day. The resident should remain in respiratory isolation until TB is diagnosed and effective treatment is initiated, or TB is ruled out. The resident’s physician and the public health department should be consulted for guidance regarding when a resident with infectious TB disease can be removed from isolation.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 25
Screening Residents
Chapter 4
Resident with a previous history of severe adverse reaction to TST Severe adverse reactions (i.e., necrosis, blistering, anaphylactic shock or ulceration) to TSTs are rare events. Residents who provide a convincing verbal report of a severe adverse reaction to a prior TST, even if the reaction is not documented, should NOT receive a TST. Substitute an IGRA for the TST if it is available. If an IGRA is not available, document the severe reaction, conduct the TB symptom screen and review TB history and TB risk factors.
Resident refusal Residents who refuse a TST should be screened using an IGRA. Residents who refuse an IGRA should be screened using a TST. Residents who refuse both the TST and IGRA should receive a chest X-ray to rule out infectious TB disease.
Page 26 • July 2013
Regulations for Tuberculosis Control in Minnesota Health Care Settings
Chapter 4 Baseline TB Screening Tool for Nursing Home and Boarding Care Home Residents (page 1)
Baseline TB Screening Tool for Nursing Home and Boarding Care Home Residents ______________________________________
_____/_____/______
____/____/_______
Last name, first name, middle initial
Date of birth
Date form completed
Baseline TB screening includes three components: (1) Assessing for current symptoms of active TB disease *and* (2) Assessing the resident’s TB risk factors and TB history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a two-step TST.
Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)
Chest pain
Night sweats
Coughing up blood
Weight loss/poor appetite
Fever/chills
Fatigue
Note: If TB symptoms are present, promptly refer patient for a chest X-ray and medical evaluation. Do not wait for the TST or TB blood test result.
Resident’s history and risk factors (circle response) Ever had a positive reaction to a TB skin test or TB blood test? Yes No If yes: Date______________ Number of millimeters of induration ______ Had a TB skin test in the past 12 months? Yes No If yes: Date______________ Number of millimeters of induration ______ BCG vaccine?
Yes
Result_________________ Comments No Unknown
Treated for latent TB infection?
Yes
No
Unknown
Treated for active TB disease?
Yes
No
Unknown
Had a known exposure to TB < 2 years ago?
Yes
No
Unknown
Born outside of the U.S.?
Yes
No
Unknown
Traveled or lived outside of the U.S. in the past 2 years?
Yes
No
Unknown
HIV-infected?
Yes
No
Unknown
Immune suppressed*?
Yes
No
Unknown
History of substance abuse?
Yes
No
Unknown
End stage renal disease, diabetes, or silicosis?
Yes
No
Unknown
Scarring/fibrosis on chest X-ray?
Yes
No
Unknown
Undernourished or underweight (< 90% of ideal)
Yes
No
Unknown
Live-virus vaccine within the past 6 weeks?
Yes
No
Unknown
Severe adverse reaction to a TB skin test?
Yes
No
Unknown
*i.e., taking immunosuppressive drugs (equivalent to greater than 15 mg of prednisone a day for 1 month or longer) or TNF alpha inhibitor drugs such as Enbrel®, Humira®, or Remicade® for treatment of rheumatoid arthritis, Crohn's disease, or other autoimmune disorders
Tool address:
www.health.state.mn.us/divs/idepc/diseases/tb/rules/tbscrnbchnh.doc
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 27
Chapter 4 Baseline TB Screening Tool for Residents Template (page 2) TB Blood Test Name of TB blood test (circle)
QuantiFERON TB-Gold
QuantiFERON-TB-Gold InTube
T-SPOT
Date of blood draw Results Interpretation of reading (circle)
Positive* Negative
Indeterminate
Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease
Tuberculin skin testing (TST) TST – First Step
TST – Second Step
Administration Name of person administering test Date and time administered Location (circle)
L forearm R forearm Other:________ L forearm R forearm Other:________
Tuberculin manufacturer Tuberculin expiration date and lot # Signature of person who administered test Results (read between 48-72 hours) Date and time read: Number of mm of induration: (across forearm)
____mm
____mm
Interpretation of reading* (circle)
Positive** Negative***
Positive** Negative
Reader’s signature *Consult grid at www.health.state.mn.us/divs/idepc/diseases/tb/candidates.pdf ** Refer HCW for a chest x-ray to rule out active TB disease *** If results are negative, perform the second step in one to three weeks
Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center
Tool address: Page 28 • July 2013
www.health.state.mn.us/divs/idepc/diseases/tb/rules/tbscrnbchnh.doc Regulations for Tuberculosis Control in Minnesota Health Care Settings
Chapter 4 Baseline TB Screening Tool for Residents in Residential Hospice Template
Baseline TB Screening Tool for Residents in Residential Hospice ______________________________________
_____/_____/______
____/____/_______
Last name, first name, middle initial
Date of birth
Date form completed
Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)
Chest pain
Night sweats
Coughing up blood
Weight loss/poor appetite
Fever/chills
Fatigue
Note: If TB symptoms are present, promptly refer patient for a chest X-ray and full medical evaluation. Do not wait for the TST or IGRA result.
Tool address:
www.health.state.mn.us/divs/idepc/diseases/tb/rules/tbscrnrh.doc
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 29
Glossary Term
Defined as
active tuberculosis (TB) disease
Condition caused by Mycobacterium tuberculosis that has progressed to causing clinical or subclinical disease. TB disease usually affects the lungs, but it can also affect other parts of the body, such as the lymph nodes, bone, or brain. If TB is treated properly, most people can be cured. If TB is NOT treated properly, the disease can be fatal or develop into drug-resistant forms of TB. Compare to latent TB infection (LTBI). See also extrapulmonary TB and pulmanary TB.
airborne infection isolation (AII)
Isolation of patients infected with organisms that are spread via airborne droplet nuclei smaller than five microns in diameter (e.g., M. tuberculosis).
Bacille CalmetteGuérin (BCG) vaccine
A vaccine for TB used in many countries where active TB disease is endemic. It is not used in the United States. BCG vaccine helps prevent disseminated and meningeal TB disease in infants and young children, but offers much less protection for adults.
baseline TB screening
The initial screening for TB performed at the time that HCWs begin work or residents are admitted to a health care facility. Baseline screening identifies individuals with LTBI or active TB disease and is also used to compare with any future screening results. See also TB screening.
boosting
A phenomenon in which people who are skin tested many years after becoming infected with M. tuberculosis may have a negative reaction to an initial TST, followed by a positive reaction to a TST given up to a year later; this happens because the first TST boosts the immune response. Twostep testing is used in TB screening programs to tell the difference between boosted reactions and reactions caused by recent infection (see two-step TST). Boosting does not pertain to interferon gamma release assays (IGRAs).
conversion
A change in the result of a test for M. tuberculosis infection (TST or IGRA) which is interpreted as having progressed from uninfected to infected. An increase of ≥10 mm in induration during a maximum of two years is defined as a TST conversion for the purposes of employee surveillance programs. A conversion indicates that a new M. tuberculosis infection has likely occurred; this poses an increased risk for progression to active TB disease.
exposure
Being subjected to something (e.g., an infectious agent) that could have an adverse health effect. A person exposed to M. tuberculosis does not necessarily become infected. See also transmission.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 31
Glossary Term
Defined as
extrapulmonary TB
Active TB disease in any part of the body other than the lungs (e.g., lymph nodes, bone). An individual can have both pulmonary and extrapulmonary TB disease at the same time. Extrapulmonary TB is typically not considered infectious.
facility
A physical building or set of buildings.
facility TB risk assessment
An initial and ongoing evaluation of the risk for transmission of M. tuberculosis in a particular health care setting. To perform a risk assessment, the following factors should be considered: the community rate of TB, number of TB patients encountered in the setting, and the speed at which patients with active TB disease are suspected, isolated, and evaluated. The TB risk assessment determines the types of administrative and environmental controls and respiratory protection needed for a setting.
health care setting
A place where health care is delivered.
health care workers (HCWs)
Paid or unpaid person working in a health care setting.
hemoptysis
Coughing up of blood or blood-tinged sputum; one of the possible symptoms of pulmonary TB disease. Hemoptysis can also be observed in other pulmonary conditions (e.g., lung cancer).
induration
A palpable, raised, hardened area that may develop in response to the injection of tuberculin antigen. Induration is measured in only one direction (across the forearm), and the result is recorded in millimeters. The measurement is compared with guidelines to determine whether the test result is classified as positive or negative.
infectious
The ability of an individual with active TB disease to transmit (spread) TB bacteria to other persons. Directly related to the number of TB bacteria that the individual expels into the air. Persons who expel many bacilli are more infectious than those who expel few or no bacilli.
interferon gamma release assay (IGRA)
A test that detects the presence of M. tuberculosis infection by measuring the immune response to the TB bacteria in the blood. There are two commercially available IGRAs: QuantiFERON-TB and T-Spot.
Page 32 • July 2013
Regulations for Tuberculosis Control in Minnesota Health Care Settings
Glossary Term
Defined as
latent TB infection (LTBI)
Persons with latent TB infection have M. tuberculosis organisms in their bodies but do not have active TB disease, have no symptoms, and are noninfectious. Such persons usually have a positive reaction to a TST or IGRA.
Mantoux tuberculin skin test
see tuberculin skin test
medical evaluation
A process for diagnosing active TB disease or LTBI, selecting treatment, and assessing response to therapy. A medical evaluation can include medical history and TB symptom screen, clinical or physical examination, screening and diagnostic tests (e.g., TSTs, IGRAs, chest X-rays, bacteriologic examination, and HIV testing), counseling, and treatment referrals.
Mycobacterium tuberculosis (M. tuberculosis or M. tb)
A type of tuberculous mycobacteria; a gram-positive bacterium that causes tuberculosis. Sometimes called the tubercle bacillus.
potential ongoing transmission
A risk classification for TB screening, including testing for M. tuberculosis infection when evidence of ongoing transmission of M. tuberculosis is apparent in the setting. Testing might need to be performed every 8–10 weeks until lapses in infection controls have been corrected, and no further evidence of ongoing transmission is apparent. Use potential ongoing transmission as a temporary risk classification only. After corrective steps are taken and conversion rates stabilize, reclassify the setting as medium risk for a period of at least one year.
pulmonary TB
Active TB disease that occurs in the lung, usually producing a cough that lasts ≥ 3 weeks.
purified protein derivative (PPD) (tuberculin)
A material used in the tuberculin skin test for detecting infection with M. tuberculosis. In the United States, PPD solution is approved for administration as an intradermal injection (5 TU per 0.1 mL), a diagnostic aid for LTBI (see tuberculin skin test).
respiratory protection
The use of N-95 or other respirators to protect a HCW from inhaling droplet nuclei containing M. tuberculosis.
serial TB screening
TB screening performed at regular intervals following initial baseline TB screening.
Regulations for Tuberculosis Control in Minnesota Health Care Settings
July 2013 • Page 33
Glossary Term
Defined as
symptom screen
A procedure used during a clinical evaluation in which patients are asked if they have experienced any of the common symptoms of active TB disease (e.g., cough, weight loss, night sweats).
TB blood test
see IGRA
TB screening
Methods used to identify persons who have active TB disease or LTBI. May include one or more of the following: TST, IGRA, chest x-ray, symptom screening.
transmission
Transmission occurs when a person inhales droplet nuclei containing M. tuberculosis, and the droplet nuclei transverse the mouth or nasal passages, upper respiratory tract, and bronchi to reach the alveoli of the lungs, resulting in infection.
tuberculin skin test (TST)
Skin test used to detect TB infection. Sometimes referred to as “PPD” or “Mantoux.”
two-step TST
Procedure used for the baseline skin testing of persons who will receive serial TSTs (e.g., HCWs and residents of long term care facilities) to reduce the likelihood of mistaking a boosted reaction for a new infection. If an initial TST result is classified as negative, a second step of a two-step TST should be administered 1–3 weeks after the first TST result was read. If the second TST result is positive, it probably represents a boosted reaction, indicating infection most likely occurred in the past and not recently. If the second TST result is also negative, the person is classified as not infected.
Page 34 • July 2013
Regulations for Tuberculosis Control in Minnesota Health Care Settings
Baseline TB Screening Tool for Health Care Workers (HCWs) ______________________________________ Last name, first name, middle initial
____/____/______ Date form completed
____/____/_____ Date of birth
(______)____________ Work phone number
Baseline TB screening includes three components:
(1) Assessing for current symptoms of active TB disease *and* (2) Assessing HCW’s history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a two-step TST.
Symptoms of active TB disease (circle all that are present) Coughing (>3 weeks)
Chest pain
Night sweats
Coughing up blood
Weight loss/poor appetite
Fever/chills
Fatigue
Note: If TB symptoms are present, promptly refer HCW for a chest X-ray and medical evaluation before starting work. Do not wait for the TST or TB blood test result. HCW’s history (circle response) Have you ever had a positive reaction to a TB skin test or TB blood test? Yes No If yes: Date______________ Number of millimeters of induration ______ Have you had a TB skin test in the past 12 months? Yes No If yes: Date______________ Number of millimeters of induration ______ Result ______________ Comments Have you ever had the BCG vaccine?
Yes
No
Have you ever been treated for latent TB infection?
Yes
No
Have you ever been treated for active TB disease?
Yes
No
Have you ever had an adverse reaction to a TB skin test?
Yes
No
Have you received a live-virus vaccine within the past 6 weeks?
Yes
No
TB Blood Test Name of TB blood test (circle)
QuantiFERON TB-Gold
QuantiFERON-TB-Gold InTube
T-SPOT
Date of blood draw Results Interpretation of reading (circle)
Positive*
Negative
Indeterminate
Laboratory *Refer HCW for a chest x-ray and medical examination to rule out active infectious TB disease
Tuberculin skin testing (TST)
TST – First Step
TST – Second Step
Administration Name of person administering test Date and time administered Location (circle)
L forearm R forearm Other:________ L forearm R forearm Other:________
Tuberculin manufacturer Tuberculin expiration date and lot # Signature of person who administered test Results (read between 48-72 hours) Date and time read: Number of mm of induration: (across forearm)
____mm
____mm
Interpretation of reading* (circle)
Positive** Negative***
Positive**
Negative
Reader’s signature *Consult grid at www.health.state.mn.us/divs/idepc/diseases/tb/candidates.pdf ** Refer HCW for a chest x-ray to rule out active TB disease *** If results are negative, perform the second step in one to three weeks
Adapted by the Minnesota Department of Health TB Prevention and Control Program from materials produced by the Global TB Institute and the Francis J. Curry National TB Center
Comprehensive Home Care Resource Manual – 4.07 [Name of Company] SAMPLE TREATMENT/ THERAPY MANAGEMENT PLAN Client Name: ___________________________________________________ Services being provided/ delegated to Unlicensed Personnel (ULP) include: ☐ Bed Positioning Device ☐ Occupational Therapy ☐ BiPAP ☐ Ostomy ☐ Blood Glucose Monitoring ☐ Oxygen ☐ Brace Assistance ☐ Oxygen Saturation ☐ Physical Therapy ☐ Catheter Care ☐ Compression Garments ☐ Range of Motion (ROM) ☐ CPAP ☐ Skilled Nursing ☐ Specialty Diet: ___________ ☐ INR Monitoring __________________________ ☐ Lymphedema Wraps __________________________ ☐ Nebulizer
☐ Suction ☐ Tube Feeding ☐ Vital Signs (provider ordered) ☐ Weight monitoring (provider ordered) ☐ Wound Care ☐ Other: _________________ __________________________ __________________________
Documentation of specific client instructions relating to the administration of treatments/ therapy is located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: _______________________________________ Staff will notify a licensed nurse or appropriate licensed health professional when a problem arises with treatment/ therapy management services, including refusals and potential treatment inaccuracies. Specific parameters regarding treatments are also located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: ________________________________________ Any client specific requirements relating to documenting treatments/ therapy services are located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: ________________________________________ Verification that all treatments/therapy services are administered/carried out as prescribed or ordered is located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Other: ________________________________________
© July 2019 Care Providers of Minnesota
Page 1 of 2
Comprehensive Home Care Resource Manual – 4.07 Monitoring of treatment or therapy to prevent possible complications or adverse reactions is located: ☐ On the client Treatment Administration Record (TAR) ☐ In Electronic Health Records (EHR) / Service Tasks ☐ Routine monitoring by nurse ☐ Other: ________________________________________ **This Medication/Treatment/Therapy Management Plan will be reviewed and updated as needed. Completed by: _____________________________________________Date:___________________ (Signature and Title)
© July 2019 Care Providers of Minnesota
Page 2 of 2
Comprehensive Home Care Survey Self-Audit Tool
Topic: Medication Management and Administration Audited by:_____________________________ Date of Audit:___________________________
Note: The following terms and definitions are used in the Comprehensive Home Care statutes: "Medication" means a prescription or over-the-counter drug and includes dietary supplements.
"Medication administration" means performing a set of tasks to ensure a client takes medications, and includes the following: • • • • •
Checking the client's medication record Preparing the medication as necessary Administering the medication to the client Documenting the administration or reason for not administering the medication Reporting to a nurse any concerns about the medication, the client, or the client's refusal to take the medication.
"Medication management" means the provision of any of the following medication-related services to a client: • • • • • • • • •
Performing medication setup Administering medication Storing and securing medications Documenting medication activities Verifying and monitoring effectiveness of systems to ensure safe handling and administration Coordinating refills Handling and implementing changes to prescriptions Communicating with the pharmacy about the client's medications Coordinating and communicating with the prescriber
"Medication setup" means arranging medications by a nurse, pharmacy, or authorized prescriber for later administration by the client or by comprehensive home care staff.
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Medication Management Audit Tool Page 1 of 4
Task: 1. 2. 3. 4.
Make five copies of this blank form Retrieve home care policies and procedures regarding medication management Retrieve five random client medication records Retrieve five employee records of random unlicensed staff that perform delegated medication management services
Review the items for compliance with the following requirements:
Requirement If you provide medication management services, your home care agency has developed, implemented, and maintained current written medication management policies and procedures. Documentation exists to indicate your medication management policies and procedures were developed under the supervision and direction of a RN, licensed health professional, or pharmacist, consistent with current medical practice standards and guidelines. The medication management policies and procedures address preparing and giving medications. The medication management policies and procedures address verifying that prescription medications are administered as prescribed. The medication management policies and procedures address documenting medication administration and related activities. The medication management policies and procedures address controlling and storing medications. The medication management policies and procedures address monitoring and evaluating medication use. The medication management policies and procedures address investigating and resolving medication errors. The medication management policies and procedures address communicating with the prescriber, pharmacist, and client/client's representative regarding medication issues. The medication management policies and procedures address educating clients and client’s representatives about medications. The medication management policies and procedures address how medication supplies are monitored, how refills are ordered in a timely manner, and how medication refills are received and put into use.
Met
Not N/A Met
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Medication Management Audit Tool Page 2 of 4
Requirement The medication management policies and procedures identify: 1. How the home care provider will ensure the security of medications 2. How the home care provider will ensure accountability of medications 3. How the home care provider will provide overall management of medications 4. How the home care provider will control medications 5. How the home care provider will dispose of controlled substances. If the home care provider permits unlicensed staff to provide medication management for client's within unanticipated leaves (leave not to exceed 120 hours), the provider must have a policy and procedures outlining the following: 1. Permissible situations 2. Written instructions for clients 3. Availability and use of appropriate containers 4. Labeling instructions 5. Provider contact information 6. Advance training and competency testing by a RN 7. Any special requirements for controlled substances 8. Information to be documented in the record 9. A review by a RN after the fact. Home care providers providing medication management services must have policies and procedures in place regarding the loss or spillage of controlled substances. Home care providers providing medication management services must have policies and procedures in place to investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state and federal regulations, and document the investigation in required records. If the home care provider does not require a prescription for over-thecounter medications or dietary supplements, but does manage those items, verify that the home care provider retains the items in their original labeled containers with directions for use prior to setting up or later administration. If a home care provider becomes aware of any medications or dietary supplement used by a client that were not included in the assessment for medication management services, home care provider staff advised the RN and document it in the client record. Verify that documentation exists identifying staff persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis.
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The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Medication Management Audit Tool Page 3 of 4
Requirement Verify that prescription drugs for one client are not used or saved for use by anyone other than the client it was prescribed for. Verify that when client refuse to take medications as prescribed when medication management is being provided, the refusal is documented in the client record. Verify that medications are administered by a nurse, physician, or other licensed health care practitioner authorized to administer medications OR by unlicensed personnel who have been delegated medication administration tasks by a RN. Verify that documentation shows that unlicensed personnel delegated to administer medications have been instructed by a RN in the proper methods to administer medications. Verify that documentation shows that unlicensed personnel delegated to administer medications have demonstrated competency to a RN, the ability to competently follow the medication administration procedures. Verify that RNs provide instructions to unlicensed personnel providing delegated medication management services regarding the individual needs of each client.
Met
Not N/A Met
If any applicable requirements are identified as “Not Met”, correct the situation, audit other records, procedures, forms, software, and staff responsibilities to correct the problem going forward. References: 144A.4792 Subd. 1 (b), 144A.4792 Subd. 1 (c), 144A.4792 Subd. 10, 144A.4792 Subd. 12, 144A.4792 Subd. 18, 144A.4792 Subd. 21, 144A.4792 Subd. 23 (a), 144A.4792 Subd. 23 (b), 144A.4792 Subd. 4, 144A.4792 Subd. 6, 144A.4792 Subd. 7 (1), 144A.4792 Subd. 7 (3), 144A.43 Subd. 10-13
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Medication Management Audit Tool Page 4 of 4
Comprehensive Home Care Survey Self-Audit Tool
Topic: Abuse Prevention Plans Audited by:_____________________________ Date of Audit:___________________________ Note: Individualized abuse prevention plans are required to be completed for all home care clients when they become a client. Many survey deficiencies are issued when the client’s vulnerability has changed, but the abuse prevention plan has not been updated to reflect the new vulnerability along with new approaches to protect the client. Task: 1. Make five copies of this blank form 2. Retrieve five client records, preferably of client’s whose conditions or behaviors have worsened recently Review the items for compliance with the following requirements:
Requirement Each client record contains a current individualized abuse prevention plan. The client vulnerabilities outlined in the abuse prevention plan match the current status of the client. Each abuse prevention plan contains: 1. The client’s susceptibility to abuse by other individuals (including other clients) 2. The client’s risk of abusing other vulnerable adults (including other clients) 3. Statements of the specific measures to be taken by the home care agency (or others) to minimize the risk of abuse to that client and other home care clients The specific measures outlined have proven to be effective in preventing abuse to the client or against other clients.
Met
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If any applicable requirements are identified as “Not Met”, correct the situation, audit other records to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward.
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Abuse Prevention Plans Audit Tool Page 1 of 2
Hint: Vulnerabilities commonly associated with survey deficiencies: o o o o o o o o o o o o o o o o o o o o
Dialysis Dementia, Confusion, Cognitive Deficits Traumatic Brain Injury Parkinson’s Socially inappropriate behaviors (sexual) Hallucinations, Delirium Elopements Wandering into other tenants apartments Aggressive behavior (verbal, physical, threatening, combative) Inability to summon for assistance Inability to follow directions Inability to communicate needs Behavior symptoms Sensory limitations Chronic Pain Suicidal threats Frequent falls Frequent bruising Lacking ability to adhere to safety precautions consistently Unsafe smoking
Reference: 626.557 Subd. 14
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Abuse Prevention Plans Audit Tool Page 2 of 2
Before a side rail is utilized, a number of issues should be considered and addressed, such as: What is the intended and functional purpose of the side rail? • • • •
Side rails have proven to be ineffective at keeping adult bed occupants from rolling or falling out of bed. Side rails are never to be used as a form of restraint - if they prevent the bed occupant from independently exiting the bed...they are acting as a restraint. The potential for serious injury is more likely to be related to a fall from a bed with raised side rails when the patient attempts to climb over, around, between, or through the rails, than from a bed without side rails in use. Side rails can be an effective device to assist with repositioning while in the bed or as an aid to getting into or out of the bed.
Is the home care client a safe “match” for a side rail? • •
The population at risk for entrapment are clients who are frail or elderly or those who have conditions such as agitation, delirium, confusion, pain, uncontrolled body movement, hypoxia, fecal impaction, and acute urinary retention that cause them to move about the bed or try to exit from the bed. Initial and ongoing evaluation and monitoring of the client and side rail should occur.
Will the side rail be installed, utilized, and maintained in accordance to the manufacturer’s recommendations? • • •
Side rails must be designed to work with the bed “system”, including the siderail, bed frame, and mattress. Loose or “wobbly” side rails should not be used. Side rails designed for youth or children are not meant to be used with adults and should not be used.
Does the side rail being considered meet or exceed the FDA’s dimensional guidance to reduce entrapments? • • • •
The Minnesota Department of Health has determined that in order to meet accepted health, medical, and nursing standards of practice, side rails known to be used by a client of a licensed home care provider must meet the FDA’s dimensional guidance. To meet the FDA’s dimensional guidance, each designated space in zones 1-3 must not exceed 4 3/4 inches and zone 4 must not exceed 2 3/8 inches (see front for zone pictorial). Many (not all) rental beds are sent with side rails that do not meet the FDA’s dimensional guidance to reduce entrapment. When the design and use of a side rail is unsafe; strangulation, suffocation, bodily injury, or death can occur when clients or parts of their bodies are caught between side rails or between the side rails and mattresses. Refer to the drawings to the right.
Based on the responses to these issues, an evaluation should be conducted to assess the relative risk of using the side rail compared with not using it for each individual client. Clients and their family members should be educated about possible side rail danger to enable them to make an informed decision; including options for reducing the risks of side rail use. The client’s right to participate in care planning and make choices should be balanced with the home care provider’s and caregiver’s responsibility to provide care according to an individual assessment, professional standards of care, and any applicable state and federal laws and regulations.
Drawings of Siderail Entrapments
Between January 1, 1985 and January 1, 2013, the U.S. Food and Drug Administration (FDA) received 901 incidents of patients caught, trapped, entangled, or strangled in hospitaltype beds. The reports included 531 deaths, 151 nonfatal injuries, and 220 cases where staff needed to intervene to prevent injuries.
This brochure was developed by Care Providers of Minnesota, a trade association representing providers of home care and assisted living services.
Most patients were frail, elderly or confused. Not all clients are at risk for side rail entrapment, and not all side rails and bed systems pose a risk of entrapment. Side rails can prove very useful in certain limited situations. However, side rails can also function as a form of restraint, create a danger of the client falling to the floor from a greater height, create an entrapment danger, and even be a cause of death. In response to continued reports of patient entrapments and deaths, the FDA, in partnership with the U.S. Department of Veterans Affairs, Health Canada’s Medical Devices Bureau and representatives from national health care organizations and provider groups, patient advocacy groups, and medical bed and equipment manufacturers, formed a working group in 1999 known as the Hospital Bed Safety Workgroup (HBSW). Using retrospective studies of side rail related deaths, the HBSW identified 7 potential entrapment zones in hospital beds and published side rail design dimensional guidance for bed manufacturers to minimize entrapments. Unfortunately, many side rails in use around the world do not meet the recommended dimensional guidance, and entrapment injuries and deaths continue to occur.
Using Bed Side Rails in Home Care and Assisted Living Settings
The intended purpose of this brochure includes:
• Elimination of preventable entrapments and injuries caused by the unsafe use of side rails • Elimination of preventable deaths caused by the unsafe use of side rails • Elimination of side rails acting as restraints • Provide education to providers and consumers regarding side rail safety • Provide a tool for home care agencies to use in educating clients and client’s representatives about the risks and benefits of side rails • Decrease the frequency of side rail related home care survey deficiencies issued by the Minnesota Department of Health regarding side rail use This brochure was provided by:
For more information: http://www.fda.gov/medicaldevices/productsandmedicalprocedures/ generalhospitaldevicesandsupplies/hospitalbeds/default.htm The material in this pamphlet is for informational purposes only and not for the purpose of providing medical or legal advice. The information provided is not a substitute for medical or professional care, and you should not use the information in place of a call consultation or the advice of your physician or other healthcare provider. Care Providers of Minnesota is not liable or responsible for any advice, course of treatment, diagnosis or any other information, in this pamphlet.
2015 V1.4
Entrapment Zones
Each year many home health care professionals, home care clients, and family members of clients request that a side rail be attached to a client’s bed. The basis of the request is generally to prevent a fall from the bed, provide assistance with transferring in or out of the bed, or providing assistance with repositioning while in the bed. This brochure is designed to help home care providers and home care clients better understand the potential risks and benefits resulting from the use of side rails.
Comprehensive Home Care Survey Self-Audit Tool
Topic: Client Records Audited by:_____________________________ Date of Audit:___________________________ Task: Locate the following items: 1. 2. 3. 4.
Make five copies of this blank form Retrieve a sample of five random client files Retrieve two samples of discharged client files Retrieve all policies and procedures regarding client records
Review the items for compliance with the following requirements:
Requirement There is a client record for the client and the record is: 1. Current 2. Legible 3. Permanently recorded (no pencil) 4. Dated 5. Includes the name and title of each person making an entry The client record, whether written or electronic, is protected against loss, tampering, or unauthorized disclosure. There are written policies and procedures to control the use, storage and security of the client record. The client record is readily available to home care employees or contractors authorized to access the record. The client record is maintained in a manner that allows timely access, printing or transmission, as needed. The client record contains identifying information including the client’s: 1. Name 2. Date of birth 3. Address 4. Telephone number The client record contains the name, address, and telephone number of the client’s: 1. Identified emergency contact 2. Family members 3. Client’s representative (if any) 4. Others as identified by the client
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The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Client Records Audit Tool Page 1 of 4
Requirement The client record contains the name, address, and telephone number of the client’s identified health and medical service providers and other home care providers that are being used by the client (if known.) The client record contains health information, including: 1. Medical history 2. Allergies 3. Any other relevant health records When the home care provider is providing medication management services, treatments or therapy services, the client record contains relevant documentation. The client record contains any advance directives such as a living will, health care directive, POLST, etc. (if any). The client record contains the current and most recent previous assessments. The client record contains the current and most recent previous service plans. The client record contains all records of communication pertinent to the client’s home care services. The client record contains documentation of significant changes in the client’s status and actions taken in response to the needs of the client including reporting to the appropriate supervisor or health care professional. The client record contains, in writing by an RN, specific instructions for medication management delegated to unlicensed personnel. Each medication administered is documented in the client record. Each medication administered and documented in the client record includes: 1. The signature of the person who administered the medication 2. The title of the person who administered the medication 3. The name of the medication 4. The dose of the medication 5. The date the medication was administered 6. The time the medication was administered 7. The method and route of administration If a medication is not administered as prescribed, staff have documented the reason it was not administered as prescribed and any follow-up procedures that were provided to meet the client’s needs. If the client has refused to take medication as prescribed when medication management is being provided, education/discussion and possible consequences of the client refusal is documented in the client record. Documentation in the client’s record of treatment or therapy service administered includes: 1. The signature of the person who administered the service
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The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Client Records Audit Tool Page 2 of 4
Requirement 2. The title of the person who administered the service 3. The date and time when the service was provided The client record contains documentation that services have been provided as identified in the service plan. The client record contains documentation that the client (or client’s representative) has received and reviewed the appropriate version of the home care bill of rights. The client record contains documentation that the client (or client’s representative) has received the home care statement of disclosure and limitations of services document. The client record contains documentation of complaints received and the resolution of complaints received. The client understands they have a right to access their own records and written information from those records. If medications have been disposed of by the home care provider, documentation in the client record includes: 1. Disposition of the medication 2. The medication’s name 3. The medication’s strength 4. The medication’s prescription number (if applicable) 5. Quantity of medication disposed 6. To whom (if anyone) the medications were given, 7. Date of disposition 8. Names of staff and other individuals involved in the disposition The client record contains a discharge summary, including service termination notice and related documentation. Copies of client records are kept by the home care provider for a period of five years following a client’s discharge or termination of services. The home care provider, upon request of the client or client’s representative, provides a copy or summary of the client’s record to another home care provider, other health care practitioner or provider, or inpatient facility to assist with a coordinated transfer, when applicable.
Met
Not N/A Met
If any applicable requirements are identified as “Not Met”, correct the situation, audit other client records, forms, policies and procedures, and other sources of information to determine how widespread the problem is, correct all problems, and review policies, procedures, forms, software, and staff responsibilities to correct the problem going forward. Hint: If you thin out your client records in anyway, make sure that you and your staff remember that they are part of the entire client record and are available to surveyors if needed, including making sure there is access to them if they are located in a different area than the “active” client chart. The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Client Records Audit Tool Page 3 of 4
References: MN144A.44 Subd. 1, 144A.4792 Subd. 4, 144A.4792 Subd. 7, 144A.4792 Subd. 8, 144A.4792 Subd. 22, 144A.4793 Subd. 5, 144A.4794 Subd. 1, 144A.4794 Subd. 2, 144A.4794 Subd. 3, 144A.4794 Subd. 4, 144A.4794 Subd. 5
The use of this tool is optional. This tool is not designed to render legal advice. Based on MN laws and rules published in 2014. © 2014 Care Providers of Minnesota Client Records Audit Tool Page 4 of 4
Additional Resources: Survey Preparation & Success/Electronic Monitoring Temporary Licensed Home Care Providers Survey Forms https://www.health.state.mn.us/facilities/regulation/homecare/survey/templicensed.html Licensed Home Care Provider Survey Forms https://www.health.state.mn.us/facilities/regulation/homecare/survey/licensed.html
2021 Nurse Managers' Education Series
CLINICAL DECISION MAKING IN ASSISTED LIVING & HOME CARE SETTINGS April 7, 2021
Robert Sonntag, MD, CMD, Geriatrician, Medical Director Health Partners
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Thank you to our sponsor
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2021 Nurse Managers' Education Series
Guardian Pharmacy of Minnesota is 100% dedicated to serving nursing homes, assisted living communities, group homes, and behavioral health facilities. Entire pharmacy team focused on service excellence.
Guardian Pharmacy Minnesota 940 Industrial Drive South, Suite 102 Sauk Rapids, MN 56379
Phone: (320) 230-1050 Toll Free: (855) 502-1050 Fax: (320) 230-1051
www.guardianpharmacyminnesota.com 3
INTRODUCTIONS Robert Sonntag, MD, CMD, Geriatrician, Medical Director Health Partners Dr. Robert Sonntag is certified in Internal Medicine, Geriatrics and Hospice and Palliative Medicine. He is a geriatrician with Health Partners and a past MMDA president. He is currently the medical director of several area nursing facilities.
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Robert Sonntag MD rgsonnt@gmail.com
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Objectives List three ways to improve skills and assessments in your organization State the components of a comprehensive nursing assessment. Be prepared to promptly identify “Red flags” and avoid “Band-Aid” treatments.
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ASSESSMENT IS KEY Consider anything that is not normal for the patient/client to warrant assessment. The key question to ask is “Why is this happening?” Observations of changes in behavior, decline in functional status, changes in appetite, change in vital signs are all clues for further evaluation.
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INTERACT II Stop and Watch SBAR (situation, background, assessment, request) Care Paths (chf, pneumonia, uti, mental status changes, fever, dehydration) POLST
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WHAT TO ASSESS: A complete assessment of the patient is essential:
Vital signs Review of systems Physical exam Advance directives Current diagnoses Allergies
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VITAL SIGNS
Temperature Blood pressure including postural changes Pulse rate Oxygen saturation Respiratory rate Current and previous body weights Glucose if diabetic
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REVIEW of SYMPTOMS Respiratory Urine Abdomen Cardiac Mental Status Functional Status Discomfort, other
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Physical Examination Mental status Oral cavity Conjunctiva Skin Chest
Heart Abdomen Genitalia Peri-rectal area Central nervous system
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ADVANCE DIRECTIVES
DNR does not mean “do not respond” DNI does not mean “do not initiate”
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MISCELLANOUS 1. Diagnoses 2. Allergies
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RED FLAG FINDINGS MAY INCLUDE:
Fever Pain Anxiety/confusion/be havior disturbance Mental Status change or lethargy Nausea/vomiting/diar rhea Low O2 sats or SOB Chest Pain Acute changes
Blood (emesis/stool) Critical Lab Glucose (high/low) Weight Loss/poor po intake Edema Cough Family concerns particularly “patient not right” Falls
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RISK OF RED FLAGS Seemingly easy to treat by applying “BandAids”. Treating of the symptom often obscures the diagnosis.
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BAND-AIDS INCLUDE: Tylenol for fever Hgb for bleeding
Narcotics for pain Psychotropics for anxiety/agitation/behaviors U/A and U/C for mental status change or lethargy Compazine for nausea/immodium for diarrhea Oxygen for low O2 sats NTG for chest pain Waiting/Uncertainty
Recheck for critical lab/failure to call provider Sliding scale for abnormal glucose Supplements for weight loss/poor po intake Teds, elastic stockings for edema Robitussin for cough Ignore, failure to appreciate family concerns Alarms for falls
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FEVER Tylenol masks fever, creating a false sense of improvement. Fever is actually the bodies attempt to fight off the organism. Causes are pneumonia, UTI, cellulitis, other inflammation. Tylenol is the Band-Aid.
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PAIN Acute? Chronic? Where is it? Quality and intensity? What makes it better? Worse? Pain med is the Band-Aid.
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BEHAVIOR What is the target behavior? Is the behavior persistent? Is the behavior harmful? Has unmet needs, environmental, psychosocial or medical causes been ruled out? Will a drug improve the behavior? Are benefits & risks assessed? Is there informed consent? Psychotropic med is the Band-Aid.
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Acute Mental Status Change
New or increased lethargy, confusion, agitation, depressed mood, delusions, hallucinations. Often the first sign of illness
Start with vital signs Review of systems & exam Consider new meds as a cause Often a medical problem U/A & U/C is the Band-Aid 21
Delirium Medical illness of acute or subacute onset that presents with
psychiatric symptoms including a disturbance of consciousness and attention with a change in cognition (perception, thought, memory) and/or perceptual impairment ( hallucinations or delusions). Symptoms may fluctuate
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Treatment of Delirium
Address underlying causes or triggering factors Prevent complications through supportive care Non drug approaches Medications – only for severe agitation or confusion that threatens safety of self or others or prevents exam or treatment – antipsychotics Prevention
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NAUSEA / VOMITING / DIARRHEA
Vital signs i.e., fever Other symptoms? How long going on? New medications? Evidence of dehydration? Compazine or Immodium is the Band-Aid
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LOW O2 SATS Significant issue and often bad Pneumonia, CHF, Pulmonary embolus Lack of assessment occurs often Oxygen is the Band-Aid
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CHEST PAIN Giving NTG is making an assessment and implies angina New angina is a critical diagnosis Using NTG from standing orders and not calling provider is always wrong NTG is the Band-Aid
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Acute Change When the poop is hitting the revolving blade! How to recognize bad stuff leading to hospitalization or worse Bad stuff is acute changes in condition that may manifest as a change in mental status, changes in vital signs, new onset of pain, new neurologic issues, or new GI or pulmonary issues. Go with your instinct, call provider or your supervisor and don’t delay. May need to dial 911 without a doctor order. Band aide is delay.
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BLOOD Bloody stools, vomiting blood and black stools in context of bleeding requires hospitalization Streaks of blood in vomit or stool is not bleeding but represents trauma Just rechecking Hgb is the Band-Aid
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CRITICAL LAB Always needs to be called Not faxed or left on voice mail The Band-Aid is providing results in some fashion without speaking to the provider
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ABNORMAL GLUCOSE
Sliding scale is not recommended for elderly. Improve basal insulin regimen if insulin dependent. Can be a sign that something else is occurring i.e., infection or diet change. Band-Aid is the sliding scale.
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WEIGHT LOSS/ POOR ORAL INTAKE
Dysphagia. Drug induced. Medical problems. Ill fitting dentures Dining room issue Band-Aid is the nutritional supplement
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EDEMA CHF? Symptoms? Weights? Unilateral or bilateral? New or increased? Band-Aid is TEDs
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Cough
CHF Pneumonia Aspiration Other lung conditions Upper respiratory infection Robitussin, etc. is the Band-Aid.
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FAMILY CONCERN Very important to listen. Do not minimize. Independently assess. Contact the provider. Band-Aid is reassuring family and failure to take the concern seriously.
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Falls Environment First sign of illness Unmet needs Alarms are the band-aide
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ASSESSMENT
ALL RED FLAGS should be called to the provider. Do NOT fall into the Band-Aid trap. Assessment is the “A” word. Communication is the key.
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DOCUMENT 1. 2. 3. 4.
Makes or breaks you Medical Legal Do it right away Describe event factually
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FOLLOWTHROUGH 1. Keep thinking 2. Keep assessing 3. Keep updating the provider
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The Call To The Physician
Nursing Assessment Clinical symptoms Physical exam Major diagnoses Current medications and allergies CPR status
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INTERACT II Stop and Watch SBAR (situation, background, assessment, request) Care Paths (chf, pneumonia, uti, mental status changes, fever, dehydration) POLST
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Robert Sonntag MD rgsonnt@gmail.com
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OBJECTIVES Distinguish between symptomatic and asymptomatic urinary tract infection. Describe approaches to evaluate and treat UTI’s Understand the mythology of UTI’s
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Urinary Tract Infections Common bacterial infection in older populations, both in the community as well as in the nursing home.
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No pyuria, bacteria present = No UTI
Pyuria present, bacteria present, no urinary symptoms (dysuria, flank pain, etc.) = Probably no UTI
No pyuria = No UTI
UA/UC Performed
Pyuria present, bacteria present, urinary symptoms present (fever,dysuria, flank pain, etc.) = ?UTI
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Case 1: A Woman with Dementia and Changes in Behavior
You are called by a nurse from the nursing home about Mrs. F a 97 yo woman with changes in behavior. The nurse tells you that Mrs. F is refusing care, has anger bursts, and is not sleeping as well as usual. PMH dementia, depression, osteoporosis, hypertension. She was treated for 5 days, three weeks ago for a urinary tract infection. She has been residing in the nursing home for more than 7 years, and was admitted because of her dementia that caused her to need assistance with some ADLs. 45
Nursing Assessment Medications: aspirin 81 mg, HCTZ 12.5 mg daily, losartan 100 mg daily, and mirtazapine 15 mg qhs. No recent medication changes. Vital signs: 140/90 mmHg (not orthostatic), temp 97.8F, respiratory rate 16, oxygen sat 99% on room air. Abdomen: Non tender to palpation, no flank pain.
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Your Response and Initial Testing Results
You order a CBC, chemistry panel, AST/ALT, TSH, chest x-ray, urinalysis and urine culture. They all return within normal limits except for urine with 50 WBC/hpf, +LE/+N, and > 100,000 CFU of E. coli, resistant to quinolones, and tetracycline.
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What is your next step in management? Prescribe ciprofloxacin 500 mg by mouth twice daily for 3 days Prescribe trimethoprim/sulfamethoxazole DS 1 tab by mouth twice daily for 5 days Observe for 2 to 3 days as these changes in behavior may be related to progression of dementia. Look at prior urine culture susceptibilities as this may be a partially treated urinary tract infection Call the psychiatrist as this patient needs new treatment for her depression
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Definition of Asymptomatic Bacteruria
No symptoms attributable to the genitourinary tract AND Bacteria in the urine ≥ 105 CFU/mL in a clean catch specimen or ≥ 102 CFU/ml in a catheterized specimen For clean catch 2 consecutive urine specimens in females or 1 in males.
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Relationship of Bacteriuria to ASB and UTI
Bacteriuria ASB
UTI
• Asymptomatic bacteriuria (ASB) is bacterial growth in a urine culture, “without any localizing signs/symptoms of urinary tract infection.” • Bacteriuria ≠ UTI •
UTI requires presence of symptoms
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COLONIZATION Urinary tract is normally sterile, except for the distal end of the urethra Colonization is defined as the presence of one (or several) microorganisms in the urinary tract without clinical manifestations Concept of asymptomatic bacteriuria and colonization corresponds to the same entity Some prefer the term colonization over that of asymptomatic bacteriuria
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Asymptomatic Bacteriuria is Common in the Nursing Home
15-37% of men, 25-53% of women. Causes: atrophic vaginitis, stones, incomplete emptying – cystocele, obstruction Anatomy and urine flow VARIABLE May include obstruction, stones, catheters, biofilm ? Like keeping colon sterile ? Futility
52
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2021 Nurse Managers' Education Series
Limitations of Urinary Diagnostics with Catheters Urinalysis (UA) Abnormal findings on a urinalysis in a resident with an indwelling urinary catheter are common and non-specific. • The presence of the catheter may cause local irritation of the bladder wall, resulting in WBCs in the urine. Negative (normal) urinalysis is very helpful to rule out a UTI.
Urine cultures Bacteriuria is highly prevalent in residents with indwelling urinary catheters Amount of bacteria in culture does not help with interpretation
Nicolle LE Drugs Aging (2014) 31:1–10 IDSA Guidelines, Clinical Infection Diseases 2010; 50:625-663
53
Treatment of Asymptomatic Bacteruria
High prevalence of asymptomatic bacteruria in LTC. Numerous organizations including American Medical Director’s Association and Infectious Disease Society of America advocate against treatment of asymptomatic bacteriuria due to: Presence of asymptomatic bacteriuria in older patients does not predict future UTI or mortality Treatment does not prevent recolonization or reduce risk of symptomatic UTI. Treatment correlates with increased resistance in colonizing bacteria. 54
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2021 Nurse Managers' Education Series
Normal UA Results
Normal Urine Colors are yellow, pale yellow, straw, dark yellow, amber, and colorless. Normal Urine Appearances are clear, cloudy, hazy, or turbid. Chemical
Microscopic Analysis
Constituent
Reference Range
Element
Reference Range
Glucose
Negative
White Blood Cells
Bilirubin
Negative
Ketones
Negative
Red Blood Cells
0-3/ High power field
Blood
Negative
Epithelial ells
< 6/ High Power field
pH
5.0 - 8.0
Bacteria
None
Protein
Negative
Yeast
None
Urobilinogen
0.2 - 1 mg/dL
Trichomonas
None
Nitrite
Negative
Parasites
None
Leukocyte
Negative
Mucus Threads
None or Few
Specific Gravity
1.003 - 1.033
Renal Cells
< 6/ High Power field
Male: 0-3 / high power field Female and children: 0-5/ high power field
55
PYURIA Found in >90% of asymptomatic bacteriuria Found in 100% of symptomatic UTI’s If pyuria is absent then urinary infection can be ruled out Pyuria is not sufficient for a diagnosis of a UTI because it does not differentiate between symptomatic UTI and asymptomatic bacteriuria A positive dipstick for leukocyte esterase or nitrite is not diagnostic for UTI
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Facts about Pyuria in the Nursing Home The absence of pyuria can rule out a UTI
57
MYTHOLOGY POWERFUL MYTHOLOGY ASYMPTOMATIC UTI IS A COMMON CAUSE OF FALLS AND CONFUSION
58
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Signs and Symptoms not Specific for UTI Cloudy, milky or turbid urine Malodorous urine Worsening or decline in mental status or functional status Increased behavioral and psychological symptoms of dementia (BPSD) Increased falls
59
Mental Status Change and Bacteriuria
Explored predictive value of bacteriuria for nonspecific behavioral changes in cross-section of residents without catheters Bacteriuria prevalent in 32% of all residents; 45% of residents with confusion,41% with fatigue, 42% with urgency, 50% with fever
Positive urine culture could not predict presence of symptoms Sundvall et al. BMC Family Practice 2011, 12:36
60
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2021 Nurse Managers' Education Series
Why isn’t cloudy urine a symptom of UTI? Cloudy urine, a change in urine color, foul odor, and sediment are all nonspecific Many non-urinary causes • Medications • Certain foods
Several possible urinary causes • Crystals • Bacteria
61
61
Refuting the Myth High Background Rates ASYMTOMATIC BACTERURIA – Stable Residents High rates Nonspecific Status Change – falls/confusion – from progressing dementia, meds, dehydration NO data that there is a correlations – But could be Systemic Infectious Illness
62
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OVERTREATMENT of UTI’s in the ER
153 patients with various chief complaints (18% with urinary symptoms,18% with confusion and 13% with falls) were diagnosed with a UTI Only 87 (57%) with diagnosed UTI’s had a + culture 63 of 66 (95%) with negative cultures were treated with an antibiotic No correlation between urinary symptoms and culture results (38% with urine symptoms had a positive culture and 37%with urine symptoms had a negative culture)
63
CONCLUSION ! Nearly half of older women diagnosed with a UTI in the ER did NOT have confirmatory findings on urine culture and were therefore inappropriately treated ER physicians cannot rely on a positive UA (defined as a positive nitrate or leukocyte esterase) or the presentation of urinary symptoms as a predictor of a positive culture result
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2021 Nurse Managers' Education Series
Case 2: A Man with an Indwelling Urinary Catheter
The nursing home nurse manager pages you at 3 PM during your busy day about Mr. C who just experienced syncope while walking with the physical therapist. Mr. C was admitted to the nursing home for rehabilitation after a left hip fracture. He is a retired professor and was living independently until 3 weeks ago when he fell after colliding with a dining cart at his retirement community.
65
Case 2 continued He was hospitalized for 5 days. He failed voiding trials after the hip repair surgery, thus was dismissed with a urinary catheter to the nursing home. PMH: remote history of transitional cell carcinoma of the bladder, BPH, coronary artery disease, and atrial fibrillation with high grade AV block (s/p pacemaker)
66
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Nursing Assessment Medications: warfarin 7.5 mg daily, losartan 25 mg daily, tamsulosin 0.4 mg qhs, oxycodone 5 mg q4 h PRN pain, calcium with vitamin D and laxatives. He has no known drug allergies. Vital Signs: 134/72 mmHg, pulse 62 bpm, temperature 97.7F, respiratory rate 12, and oxygen saturation 99% on room air He regained consciousness within 2 minutes
67
Your Response and Initial Testing You decide to transfer him to the ED for further evaluation. A head CT, ECG, and cardiac enzymes were normal His laboratories were normal except Hgb 9.6 (unchanged from discharge), creatinine of 1.7 and urinalysis ≥ 50 WBC/hpf, > 50 RBC/hpf, +LE/+N. Urine culture is pending.
68
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2021 Nurse Managers' Education Series
What is your next step in management? Admit to the hospital cardiac evaluation to rule out acute coronary syndrome or arrhythmia as the cause of syncope. Admit to general internal medicine for treatment of complicated urinary tract infection. Return to the nursing home and wait for urine culture results before treating. Treat with broad spectrum antibiotic by mouth for 10 days at the nursing home followed by repeated voiding trials.
69
Have You Ever Heard This?
Why not just give her an antibiotic? It won’t do any harm.
Probably P b bl the h urine. Needs an antibiotic.
Turning to antibiotics as a knee jerk reflex 70
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2021 Nurse Managers' Education Series
Why Knee-Jerk Antibiotic Use Is Bad
Reason #1: It’s Bad for the Resident
Adverse effects are common Nausea, diarrhea Allergic reactions Antibiotic-related complications (Clostridium difficile, multidrug-resistant organisms)
Wrong diagnosis will delay appropriate treatment No clinical or mortality benefit from using antibiotics in individuals with ASB No decrease in symptomatic UTI events
71
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Why Knee-Jerk Antibiotic Use Is Bad Reason #2: It’s Bad for Everyone
Bacteria become resistant Danger of running out of antibiotics that work Antibiotics won’t work when residents need them Multi-drug resistance is increasingly common
Overuse of antibiotics can increase resistant organisms in your facility. Antibiotic exposure increases risk of acquiring a resistant organism 72
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When Is Knee-Jerk Prescribing Common? In residents with....
Indwelling catheters Experiencing non-specific changes (falls, poor appetite, etc.) Family who say “they always need an antibiotic when....” In situations when the
Nurse or provider doesn’t know the resident. Provider is not present; case managed on phone. Decision is made based on a laboratory test rather than the condition of the residents. 73
73
No Benefit and Potential Harm of Treating Asymptomatic UTI
3 RCTs: treating BTU in stable residents (no catheter) – no positive effect Recurrence, No effect: mortality, chronic incontinence
Dangerous: selects antibiotic resistance, overgrowth, C. difficile, Drug interactions (Coumadin) Circumvents search of actual cause of “Functional Decline” Wrong Dx is worse than No Dx
74
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2021 Nurse Managers' Education Series
Consensus Criteria for the Diagnosis of UTI in LTC Facilities McGeer (1991)
Loeb (2001)
≥3 non-catheterized AND ≥2 cath
Non catheterized:
Fever ≥ 100.9oF or 38oC
*Fever >100oF or 37.9ooC or 1.5oC (2.4oF) increase above baseline with 1 of the following:
Dysuria alone or
Dysuria, frequency or urgency
Frequency
Flank or suprapubic pain
Urgency
Changes in urine character
Gross hematuria
Change in mental status or functional status
Suprapubic pain *Flank pain Urinary incontinence Catheterized: ≥1 sx – starred items above or rigors, delirium
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Updated McGeer Criteria
For residents without a catheter both criteria 1 and 2 must be present: 1. At least 1 of the following: a: acute dysuria or acute pain or swelling of testes, epididymis or prostate b: Fever or leukocytosis and 1 localizing symptom of the urinary tract such as costovertebral angle pain, gross hematuria ,suprapubic pain, or new marked increase in urgency, incontinence or frequency
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New Criteria Continued
c: In the absence of fever or leukocytosis then 2 or more of the following which includes suprapubic pain, gross hematuria, or new marked increase in incontinence, urgency or frequency
2. Microbiologic sub criteria: a: > 10 fifth cfu/ml of no more than 2 microorganisms in a voided sample b: At least 10 second cfu/ml of any number of microorganisms by in-andout catheter
77
Updated McGeer Criteria
A: For residents with an indwelling catheter both criteria 1 and 2 must be present: 1: At least 1 of the following: a: fever, new onset of hypotension without alternative infection site b: leukocytosis with functional or mental status decline without alternative infection site c: new onset suprapubic or costovertebral angle pain d: purulent discharge around catheter or pain swelling of testes etc.
2: Urinary catheter specimen culture of at least 10 fifth cfu/ml of any organism 78
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2021 Nurse Managers' Education Series
Which of the following meet surveillance criteria for UTI? Fever Rigors New hypotension Acute delirium or functional decline Suprapubic tenderness Flank pain or CVA tenderness Purulent drainage from the catheter insertion Acute testicular or epididymis pain or swelling
Change in urine color Cloudy urine Urinary sediment Foul-smelling urine
Stone et al. ICHE. 2012; 33: 965-977
7 9
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Another Case Mrs. Bell is an 86 year-resident of your facility. She has an indwelling catheter for the past 3 weeks to assist with healing of a sacral ulcer acquired while hospitalized.
80
80
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2021 Nurse Managers' Education Series
Case continued Yesterday her urine was clear and yellow. Today her urine is definitely cloudy, dark and smells bad. What should be done next? A. B. C. D. E.
Urinalysis Urine culture Urinalysis and antibiotics Culture and antibiotics None of the above
Would the answer change if you were told she seemed tired this morning and had decided to skip breakfast to stay in bed? 81
81
Answer to Ms. Bell’s Case Assess her clinical situation, monitor carefully Urinalysis and positive culture cannot rule in a CAUTI • Avoid in catheterized residents without clear indications
Evaluate catheter to ensure no obstruction change if needed Many reasons for behavioral change • Dehydration • Slept poorly • Medication side-effects
Offering fluids is often a better initial step with ongoing monitoring of vital signs and clinical status 82
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2021 Nurse Managers' Education Series
UTI is a Clinical Diagnosis
Non catheterized patients need fever and /or localizing urinary tract symptoms to be treated for a UTI In catheterized patients localizing symptoms are often absent. Consider UTI with delirium plus fever/leukocytosis in absence of an alternative explanation Remember Cultures are used to guide antibiotic selection and NOT treatment initiation decisions
83
Approach to Treatment
Always obtain a culture Use NFT or TMP/SMX for empiric therapy Consider Fosfomycin for MDR/XDR organisms F/U on culture results and de-escalate to narrowest spectrum antibiotic as possible Tx females for 3-5 days if no catheter and 7 days if catheter or if NFT/BL used Tx males for 7days regardless of catheter Consider alternative Dx if symptoms not improving in 24-48 hours
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2021 Nurse Managers' Education Series
Acute Uncomplicated Cystitis
Lower urinary tract symptoms do not herald serious illness Antibiotic tx in patients with acute dysuria and bacteriuria in 5 randomized placebocontrolled trials showed no benefit beyond modestly faster symptom improvement In one study improvement in symptom scores in 500 women under the age of 65 with acute cystitis treated with ibuprofen lagged about 1 day behind those treated with an antibiotic It is suggested that a safe effective urinary analgesic would be an important advance in reducing antibiotic use.
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Training About Catheter Care Education is Key Routine catheter changes, urinalysis, and culture are not required
• Front-line staff should be familiar with signs/symptoms of CAUTI • Encourage physicians to avoid unnecessary urinary diagnostic tests
86
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No pyuria, bacteria present = No UTI
Pyuria present, bacteria present, no urinary symptoms (dysuria, flank pain, etc.) = Probably no UTI
No pyuria = No UTI
UA/UC Performed
Pyuria present, bacteria present, urinary symptoms present (fever,dysuria, flank pain, etc.) = ?UTI
87
The Bottom Line Abnormal urinalysis and presence of bacteriuria cannot distinguish ASB and UTI • Decisions to test and treat must be driven by symptoms • Non-specific changes may not predict UTI
Overuse of diagnostic tests will drive antibiotic use • Increases complications related to antibiotic • May lead provider to wrong conclusion
Efforts to improve use of urine tests can decrease misdiagnosis and over-treatment of UTI 88
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References
Buhr, Gwendolyn T. Practical and Successful Approaches to Diagnosis and Prevention of Symptomatic and Asymptomatic UTI in Long Term Care Residents from a presentation at AMDA March 2011 Buhr, Gwendolyn T., Urinary Tract Infections in Long-Term Care Residents. Clinic Geriatric Med 27 (2011) 229-239 Rotjanapan, Porpon, Asymptomatic Versus Symptomatic Urinary Tract Infections in Long-TermCare-Facility Residents. Quality Partners of RI, Volume 92, No. 11, November 2009 Juthani-Mehta, Manisha, et al. Clinical Features to Identify UTI in Nursing Home Residents: A Cohort Study. J Am Geriatr Soc. 2009 June 57(6): 963-970. Surveillance Definitions of Infections in LTC: Revisiting McGeer criteria. Infection Control and Hospital Epidemiology. Oct 2012,vol. 33, no. 10 pp 965-977 Crnich and Drinka. Improving Management of UTI’s in Nursing Homes: It’s Time to Stop the Tail from Wagging the Dog. Annals of LTC, Sept 2014 pp32-36 Stone & Trautner. Distinguishing CAUTI from Asymptomatic Bacteriuria, a presentation at AMDA March 2015 Gordon. Overtreatment of presumed UTI in older women presenting to the ER, JAGs 61:788-792, 2013 Benton. Asymptomatic bacteriuria in the Nursing Home, Annals Long Term Care vol14, no7, 2006 Wisconsin Update Geriatric Medicine , Infectious Diseases by Christopher Crnich MD, Sept 2017 Finucane. Urinary Tract Infections—Requiem for a Heavyweight, JAGS 65:1650-1655, 2017 Kistler et al. Antibiotic Prescribing pathway for Presumed UTIs in Nursing Home Residents, JAGS 65:1719-1725, 2017 Crnich. Improving Management of UTIs in Older Adults, JAGS 65:1661-1663, 2017
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2021 NURSE MANAGERS’ EDUCATION SERIES
APPENDIX
2021 NURSE MANAGERS’ EDUCATION SERIES
APPENDIX OF OTHER RESOURCES A. 2019 Statutes Basic Home Care Comprehensive Home Care Housing with Services Assisted Living Vulnerable Adults Act Electronic Monitoring Disclosure of Special Care Status B. Statement of Home Care Services C. MDH Website References for Housing with Services and Home Care D. Reporting—Minnesota Vulnerable Adults Act and MAARC E. Federal Fair Housing Act Guidance F. EW Residential Services (Customized Living) - Workbook – Released 2/11/2020. Printout of select pages from workbook Customized Living Component Service Definitions: A Reference Guide for Computing Time for Rate-Setting Tools Additional resources: https://mn.gov/dhs/partners-and-providers/policies-procedures/ aging/elderly-waiver-residential-services/ G. New Laws Affecting Assisted Living/Home Care Changes to Licensed Comprehensive Home Care Regulations Assisted Living Licensure Retaliation Prohibited in a Registered Housing with Services Establishment HWS-AL Sample Retaliation Policy Do I need an AL License–Decision Tree Routes to becoming an Assisted Living Director–Flow Chart I’m OK Check–Decision Tree H. Electronic Monitoring Electronic Monitoring FAQs
2021 NURSE MANAGERS’ EDUCATION SERIES
2 0 1 9
STATUTES
BASI CHOMECARE COMPREHENSI V EHOMECARE HOUSI NGWI THSERV I CES ASSI STEDL I V I NG V UL NERABL EADUL T SACT EL ECTRONI CMONI TORI NG DI SCL OSUREOFSPECI ALCAREST A TUS
7851 Metro Parkway, Suite 200 Bloomington, MN 55425 952-854-2844 800-462-0024
2019 Statutes
Home Care (Basic & Comprehensive)—144A Housing with Services—144D Assisted Living—144G Vulnerable Adults Act Reporting—626.557 Electronic Monitoring—144.6502 Disclosure of Special Care Status—325F.72
Distributed by Care Providers of Minnesota © 2019 by the Revisor of Statutes, State of Minnesota. All rights reserved. October 2019
BASIC HOME CARE COMPREHENSIVE HOME CARE HOUSING WITH SERVICES ASSISTED LIVING VULNERABLE ADULTS ACT ELECTRONIC MONITORING
2019 STATUTES HOME CARE STATUTES—144A
DISCLOSURE OF SPECIAL CARE STATUS
PAGE #
Acceptance of Clients
37
Advertising
35
Assessments—Client Review & Monitoring—Basic License
38
Assessments—Temporary Plan for Initiation of Services
38
Assessments & Monitoring—Comprehensive License
38, 41 & 42
Background Studies—New License Application Owners & Managers
32
Background Studies—Staff, Contractors & Volunteers
33
Basic Home Care Description
11
Bill of Rights Bill of Rights—Assisted Living Addendum
5 7
Bill of Rights—Notification to Clients
37
Client Records— Required
47
Client Records—Access to Records
47
Client Records—Record Retention
48
Client Records—Required Contents
47
Client Records—Transfer of Records to Other Provider
48
Complaints—Record Retention
40
Complaints—Policies, Investigation and Documentation
40
Comprehensive Home Care Description
11
Definitions Dementia & Alzheimer's Disease—Notice & Staff Training Requirements
1 37 & 52
Direct Home Care Services Definition
10
Disaster & Emergency Preparedness Plan
40
Discontinuing Life-Sustaining Treatment
40
Handling of Client Finances
36
Hearings
28
Home Care & Assisted Living Advisory Council
54
Infection Prevention—Communicable Diseases
54
Infection Prevention—Infection Control Program
54
Infection Prevention—TB
54
Innovation Variance
34
License—Applications
14
License—Changes in Ownership (CHOWs)
16
License—Display of License
35
License—Exclusions from Home Care Licensure
12
HOME CARE STATUTES—144A
PAGE #
License—Exemptions from Home Care Licensure
11
License—Fees & Renewal Fees
17
License—Immediate Temporary Suspension
29
License—Renewal
15
License—Required
10
License—Suspension or Conditional Licenses
28
License—Temporary/Initial Licenses Maltreatment Compensation Fund
19 24 & 26
Maltreatment Reporting—Vulnerable Adults Act
36
Medicare Certified Providers—Coordination of Surveys
33
Medicare Certified Providers—Equivalencies
33
Medication Management—Administration of Medications
42
Medication Management—Assessment & Provision of Services
41 & 42
Medication Management—Client Refusal
42
Medication Management—Clients Who Will Be Away From Home
43
Medication Management—Delegation to Unlicensed Personnel
42
Medication Management—Documentation of Administration
43
Medication Management—Documentation of Medication Setup
43
Medication Management—General
41
Medication Management—Individualized Medication Management Plan
42
Medications—Disposal or Disposition
45
Medications—Loss or Spillage
45
Medications—OTC & Dietary Supplements Not Prescribed
44
Medications—Packaging & Original Containers
45
Medications—Prescribed & Nonprescribed
44
Medications—Prohibition of Sharing Medications
45
Medications—Provided by Client or Family Members
44
Medications—Storage
45
Prescriptions— Renewals
44
Prescriptions—Records Confidential
44
Prescriptions—Required for Managed Medications
44
Prescriptions—Verbal Orders
44
Quality Management Requirement
35
Referrals to Other Providers of Services
38
Regularly Engaged Home Care Services—Definition
10
Service Plan—Required Elements, Implementation & Revisions
38
Service Plan—Termination of Service Plan
39
Staff—Training & Competency Evaluations for Unlicensed Staff
49
Staff—Availability of Staff for Consultation
53
Staff—Delegation of Home Care Tasks
49
Staff—Documentation of Required Annual Training
53
Staff—Documentation of Required Orientation
52
Staff—Documentation of Supervision of Staff Performing Home Care Services
53
Staff—Employee Records
36
Staff—Individual Contractors
49
Staff—Nurses & Other Licensed Health Professionals
48
Staff—Qualifications, Training & Competency
48
HOME CARE STATUTES—144A
PAGE #
Staff—Required Annual Training
52
Staff—Required Orientation Topics
51
Staff—Supervision of Staff Performing Home Care Services
53
Staff—Temporary Staff
49
Staff—Unlicensed Personnel Qualifications
48
Statement of Home Care Services
37
Surveys—Fines for Correction Orders
23
Surveys—Fines for Maltreatment
24
Surveys—Frequency
9 & 20 & 22
Surveys—Process
22
Surveys—Reconsiderations for Correction Orders
25
Surveys—Correction Orders
23
Surveys—Enforcement
27
Surveys—Follow-Up Surveys
23
Surveys—Level & Scope of Correction Orders
24
Surveys—Temporary/Initial License Survey
20
Surveys—Types of Surveys
21
Termination of Home Care Services (AL)
7
Treatments & Therapies—Administration
46
Treatments & Therapies—Documentation
46
Treatments & Therapies—Elements of an Individualized Plan
46
Treatments & Therapies—Orders or Prescriptions
46
Treatments & Therapies—Policies & Procedures
45
Treatments & Therapies—Provision of Services
45
HOUSING WITH SERVICES STATUTES—144D
PAGE #
Arranged Home Care Provider Disclosure
62
Contracts—Documentation and Storage
62
Contracts—Record Retention
62
Contracts—Required Elements for Housing with Services
60
Definitions—Housing with Services Establishments
57
Dementia Care Training Required
63
Dementia Care Training—Enforcement and Fines
65
Housing with Services—Emergency Planning and Preparedness
67
Housing with Services—Manager Requirements
66
Housing with Services—Optional Registration
59
Housing with Services—Registration Required
59
Lease—Terminations
66
Long-Term Care Insurance—Definition
58
Other Laws
63
Registration of Housing with Services
59
Restraints
66
ASSISTED LIVING STATUTES—144G
PAGE #
Assisted Living—Assistance with Arranged Home Care Providers
73
Assisted Living—Awake Staff Exemption
72
ASSISTED LIVING STATUTES—144G
PAGE #
Assisted Living—Nursing Assessment
73
Assisted Living—Termination of Housing with Services Contract
73
Assisted Living Term—Annual Registration with HWS Registration
71
Assisted Living Term—Title Protection
70
Minimum Requirements for Assisted Living
71
Reimbursement Under Assisted Living Service Packages
75
Reservation of Rights
74
Retaliation—Determined by Commissioner of Health
77
Retaliation Prohibited
75
Retaliation Prohibited —Employee
76
Retaliation Prohibited —Resident
76
Uniform Consumer Information Guide
75
August 1, 2021, Assisted Living Licensure
VULNERABLE ADULT ACT REPORTING STATUTES—626.557
77-159
PAGE #
Abuse Prevention Plans
174
VAA—Definitions—Abuse
177
VAA—Definitions—Accident
178
VAA—Definitions—Facility
178
VAA—Definitions—Financial Exploitation
179
VAA—Definitions—Immediate
179
VAA—Definitions—Maltreatment
180
VAA—Definitions—Mandated Reporter
180
VAA—Definitions—Neglect
180
VAA—Definitions—Vulnerable Adult VAA—External Investigation Requirements VAA—Information Required in Report
182 265 - 174 164
VAA—Internal Reporting
162
VAA—Protections for Reporters
163
VAA—Report Not Required VAA—Retaliation Prohibited for Good Faith Reporting VAA—Timing of Required Reports
ELECTRONIC MONITORING STATUTES—144.6502
161 & 162 175 161 & 162
PAGE #
Consent Form—Required Elements
186
Consent Notification—Exceptions—Notification to OOLCT
185
Consent Notification to Facilities
185
Consent to Electronic Monitoring
183
Electronic Monitoring—Definitions
183
Electronic Monitoring—Admissibility of Evidence
188
Electronic Monitoring—Dissemination of Recordings
188
Electronic Monitoring—Liability
188
Electronic Monitoring—OOLTC Immunity from Liability
188
Electronic Monitoring—Penalties
188
ELECTRONIC MONITORING STATUTES—144.6502
PAGE #
Electronic Monitoring—Required Signs at Public Entrances
187
Electronic Monitoring Authorized
183
Electronic Monitoring Device—Costs and Installation
187
Electronic Monitoring Device—Obstruction
187
Employee Discipline Related to Electronic Monitoring
188
Resident Protections Related to Electronic Monitoring
188
Roommate Refusal of Consent Related to Electronic Monitoring
184
DISCLOSURE OF SPECIAL CARE STATUS—325F.72
PAGE #
Disclosure of Special Care Status
191
Required Elements of Disclosure
191
MINNESOTA STATUTES 2019
144A.43
Minnesota's Comprehensive and Basic Licensed Home Care Regulations
HOME CARE PROGRAM 144A.43 DEFINITIONS. Subdivision 1. Applicability. The definitions in this section apply to sections 144.699, subdivision 2,and 144A.43 to 144A.482. Subd. 1a. Agent. "Agent" means the person upon whom all notices and orders shall be served and who is authorized to accept service of notices and orders on behalf of the home care provider. Subd. 1b. Applicant. "Applicant" means an individual, organization, association, corporation, unit of government, or other entity that applies for a temporary license, license, or renewal of the applicant's homecare provider license under section 144A.472. Subd. 1c. Client. "Client" means a person to whom home care services are provided. Subd. 1d. Client record. "Client record" means all records that document information about the homecare services provided to the client by the home care provider. Subd. 1e. Client representative. "Client representative" means a person who, because of the client'sneeds, makes decisions about the client's care on behalf of the client. A client representative may be aguardian, health care agent, family member, or other agent of the client. Nothing in this section expands ordiminishes the rights of persons to act on behalf of clients under other law. Subd. 2. Commissioner. "Commissioner" means the commissioner of health. Subd. 2a. Controlled substance. "Controlled substance" has the meaning given in section 152.01,subdivision 4. Subd. 2b. Department. "Department" means the Minnesota Department of Health.
Copyright © 2019 by the Revisor of Statutes, State of Minnesota. All Rights Reserved.
1
144A.43
MINNESOTA STATUTES 2019
Subd. 2c. Dietary supplement. "Dietary supplement" means a product taken by mouth that contains a dietary ingredient intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissue, glandulars, or metabolites. Subd. 2d. Dietitian. "Dietitian" is a person licensed under sections 148.621 to 148.633. Subd. 2e. Dietetics or nutrition practice. "Dietetics or nutrition practice" is performed by a licensed dietitian or licensed nutritionist and includes the activities of assessment, setting priorities and objectives, providing nutrition counseling, developing and implementing nutrition care services, and evaluating and maintaining appropriate standards of quality of nutrition care under sections 148.621 to 148.633. Subd. 3. Home care service. "Home care service" means any of the following services delivered in the home of a person whose illness, disability, or physical condition creates a need for the service: (1) assistive tasks provided by unlicensed personnel; (2) services provided by a registered nurse or licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker; (3) medication and treatment management services; or (4) the provision of durable medical equipment services when provided with any of the home care services listed in clauses (1) to (3). Subd. 3a. Hands-on assistance. "Hands-on assistance" means physical help by another person without which the client is not able to perform the activity. Subd. 3b. Home. "Home" means the client's temporary or permanent place of residence. Subd. 4. Home care provider. "Home care provider" means an individual, organization, association, corporation, unit of government, or other entity that is regularly engaged in the delivery of at least one home care service, directly in a client's home for a fee and who has a valid current temporary license or license issued under sections 144A.43 to 144A.482. Subd. 5. [Repealed by amendment, 2013 c 108 art 11 s 7] Subd. 6. License. "License" means a basic or comprehensive home care license issued by the commissioner to a home care provider. Subd. 7. Licensed health professional. "Licensed health professional" means a person, other than a registered nurse or licensed practical nurse, who provides home care services within the scope of practice of the person's health occupation license, registration, or certification as regulated and who is licensed by the appropriate Minnesota state board or agency. Subd. 8. Licensee. "Licensee" means a home care provider that is licensed under this chapter. Subd. 9. Managerial official. "Managerial official" means an administrator, director, officer, trustee, or employee of a home care provider, however designated, who has the authority to establish or control business policy. Subd. 10. Medication. "Medication" means a prescription or over-the-counter drug. For purposes of this chapter only, medication includes dietary supplements.
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Subd. 11. Medication administration. "Medication administration" means performing a set of tasks that include the following: (1) checking the client's medication record; (2) preparing the medication as necessary; (3) administering the medication to the client; (4) documenting the administration or reason for not administering the medication; and (5) reporting to a registered nurse or appropriate licensed health professional any concerns about the medication, the client, or the client's refusal to take the medication. Subd. 12. Medication management. "Medication management" means the provision of any of the following medication-related services to a client: (1) performing medication setup; (2) administering medication; (3) storing and securing medications; (4) documenting medication activities; (5) verifying and monitoring effectiveness of systems to ensure safe handling and administration; (6) coordinating refills; (7) handling and implementing changes to prescriptions; (8) communicating with the pharmacy about the client's medications; and (9) coordinating and communicating with the prescriber. Subd. 12a. Medication reconciliation. "Medication reconciliation" means the process of identifying the most accurate list of all medications the client is taking, including the name, dosage, frequency, and route by comparing the client record to an external list of medications obtained from the client, hospital, prescriber, or other provider. Subd. 13. Medication setup. "Medication setup" means arranging medications by a nurse, pharmacy, or authorized prescriber for later administration by the client or by comprehensive home care staff. Subd. 14. Nurse. "Nurse" means a person who is licensed under sections 148.171 to 148.285. Subd. 15. Occupational therapist. "Occupational therapist" means a person who is licensed under sections 148.6401 to 148.6449. Subd. 16. Over-the-counter drug. "Over-the-counter drug" means a drug that is not required by federal law to bear the symbol "Rx only." Subd. 17. Owner. "Owner" means a proprietor, a general partner, a limited partner who has five percent or more equity interest in a limited partnership, a person who owns or controls voting stock in a corporation in an amount equal to or greater than five percent of the shares issued and outstanding, or a corporation that owns equity interest in a licensee or applicant for a license.
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Subd. 18. Pharmacist. "Pharmacist" has the meaning given in section 151.01, subdivision 3. Subd. 19. Physical therapist. "Physical therapist" means a person who is licensed under sections 148.65 to 148.78. Subd. 20. Physician. "Physician" means a person who is licensed under chapter 147. Subd. 21. Prescriber. "Prescriber" means a person who is authorized by sections 148.235; 151.01, subdivision 23; and 151.37 to prescribe prescription drugs. Subd. 22. Prescription. "Prescription" has the meaning given in section 151.01, subdivision 16a. Subd. 23. Regularly scheduled. "Regularly scheduled" means ordered or planned to be completed at predetermined times or according to a predetermined routine. Subd. 24. Reminder. "Reminder" means providing a verbal or visual reminder to a client. Subd. 25. Respiratory therapist. "Respiratory therapist" means a person who is licensed under chapter 147C. Subd. 26. Revenues. "Revenues" means all money received by a licensee derived from the provision of home care services, including fees for services and appropriations of public money for home care services. Subd. 27. Service plan. "Service plan" means the written plan between the client or client's representative and the temporary licensee or licensee about the services that will be provided to the client. Subd. 28. Social worker. "Social worker" means a person who is licensed under chapter 148D or 148E. Subd. 29. Speech-language pathologist. "Speech-language pathologist" has the meaning given in section 148.512. Subd. 30. Standby assistance. "Standby assistance" means the presence of another person to assist a client with an assistive task by providing cues, oversight, and minimal physical assistance. Subd. 31. Substantial compliance. "Substantial compliance" means complying with the requirements in this chapter sufficiently to prevent unacceptable health or safety risks to the home care client. Subd. 32. Survey. "Survey" means an inspection of a licensee or applicant for licensure for compliance with this chapter. Subd. 33. Surveyor. "Surveyor" means a staff person of the department authorized to conduct surveys of home care providers and applicants. Subd. 34. Temporary license. "Temporary license" means the initial basic or comprehensive home care license the department issues after approval of a complete written application and before the department completes the temporary license survey and determines that the temporary licensee is in substantial compliance. Subd. 35. Treatment or therapy. "Treatment" or "therapy" means the provision of care, other than medications, ordered or prescribed by a licensed health professional provided to a client to cure, rehabilitate, or ease symptoms. Subd. 36. Unit of government. "Unit of government" means every city, county, town, school district, other political subdivisions of the state, or agency of the state or federal government, which includes any instrumentality of a unit of government.
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Subd. 37. Unlicensed personnel. "Unlicensed personnel" are individuals not otherwise licensed or certified by a governmental health board or agency who provide home care services in the client's home. Subd. 38. Verbal. "Verbal" means oral and not in writing. History: 1987 c 378 s 3; 1989 c 194 s 1; 1989 c 304 s 137; 1992 c 513 art 6 s 5,6; 1995 c 207 art 9 s 20; 1997 c 22 art 2 s 2,8; 1997 c 113 s 1; 2002 c 252 s 2-4,24; 2009 c 174 art 2 s 4; 2013 c 108 art 11 s 7; 2014 c 275 art 1 s 135; 2016 c 158 art 1 s 59; 1Sp2017 c 6 art 11 s 54; 1Sp2019 c 9 art 11 s 38-40 144A.44 HOME CARE BILL OF RIGHTS. Subdivision 1. Statement of rights. (a) A client who receives home care services in the community or in an assisted living facility licensed under chapter 144G has these rights: (1) receive written information, in plain language, about rights before receiving services, including what to do if rights are violated; (2) receive care and services according to a suitable and up-to-date plan, and subject to accepted health care, medical or nursing standards and person-centered care, to take an active part in developing, modifying, and evaluating the plan and services; (3) be told before receiving services the type and disciplines of staff who will be providing the services, the frequency of visits proposed to be furnished, other choices that are available for addressing home care needs, and the potential consequences of refusing these services; (4) be told in advance of any recommended changes by the provider in the service plan and to take an active part in any decisions about changes to the service plan; (5) refuse services or treatment; (6) know, before receiving services or during the initial visit, any limits to the services available from a home care provider; (7) be told before services are initiated what the provider charges for the services; to what extent payment may be expected from health insurance, public programs, or other sources, if known; and what charges the client may be responsible for paying; (8) know that there may be other services available in the community, including other home care services and providers, and to know where to find information about these services; (9) choose freely among available providers and to change providers after services have begun, within the limits of health insurance, long-term care insurance, medical assistance, other health programs, or public programs; (10) have personal, financial, and medical information kept private, and to be advised of the provider's policies and procedures regarding disclosure of such information; (11) access the client's own records and written information from those records in accordance with sections 144.291 to 144.298; (12) be served by people who are properly trained and competent to perform their duties; (13) be treated with courtesy and respect, and to have the client's property treated with respect;
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(14) be free from physical and verbal abuse, neglect, financial exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and the Maltreatment of Minors Act; (15) reasonable, advance notice of changes in services or charges; (16) know the provider's reason for termination of services; (17) at least ten calendar days' advance notice of the termination of a service by a home care provider, except at least 30 calendar days' advance notice of the service termination shall be given by a home care provider for services provided to a client residing in an assisted living facility as defined in section 144G.08, subdivision 7. This clause does not apply in cases where: (i) the client engages in conduct that significantly alters the terms of the service plan with the home care provider; (ii) the client, person who lives with the client, or others create an abusive or unsafe work environment for the person providing home care services; or (iii) an emergency or a significant change in the client's condition has resulted in service needs that exceed the current service plan and that cannot be safely met by the home care provider; (18) a coordinated transfer when there will be a change in the provider of services; (19) complain to staff and others of the client's choice about services that are provided, or fail to be provided, and the lack of courtesy or respect to the client or the client's property and the right to recommend changes in policies and services, free from retaliation including the threat of termination of services; (20) know how to contact an individual associated with the home care provider who is responsible for handling problems and to have the home care provider investigate and attempt to resolve the grievance or complaint; (21) know the name and address of the state or county agency to contact for additional information or assistance; (22) assert these rights personally, or have them asserted by the client's representative or by anyone on behalf of the client, without retaliation; and (23) place an electronic monitoring device in the client's or resident's space in compliance with state requirements. (b) When providers violate the rights in this section, they are subject to the fines and license actions in sections 144A.474, subdivision 11, and 144A.475. (c) Providers must do all of the following: (1) encourage and assist in the fullest possible exercise of these rights; (2) provide the names and telephone numbers of individuals and organizations that provide advocacy and legal services for clients and residents seeking to assert their rights; (3) make every effort to assist clients or residents in obtaining information regarding whether Medicare, medical assistance, other health programs, or public programs will pay for services; (4) make reasonable accommodations for people who have communication disabilities, or those who speak a language other than English; and
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144A.442
(5) provide all information and notices in plain language and in terms the client or resident can understand. (d) No provider may require or request a client or resident to waive any of the rights listed in this section at any time or for any reasons, including as a condition of initiating services or entering into an assisted living contract. Subd. 2. Interpretation and enforcement of rights. These rights are established for the benefit of clients who receive home care services. All home care providers, including those exempted under section 144A.471, must comply with this section. The commissioner shall enforce this section and the home care bill of rights requirement against home care providers exempt from licensure in the same manner as for licensees. A home care provider may not request or require a client to surrender any of these rights as a condition of receiving services. This statement of rights does not replace or diminish other rights and liberties that may exist relative to clients receiving home care services, persons providing home care services, or providers licensed under sections 144A.43 to 144A.482. History: 1987 c 378 s 4; 1991 c 133 s 1; 1998 c 407 art 2 s 81; 1Sp2001 c 9 art 1 s 39; 2002 c 379 art 1 s 113; 2007 c 147 art 7 s 75; art 10 s 15; 2009 c 79 art 8 s 7; 2013 c 108 art 11 s 8; 2014 c 275 art 1 s 135; 2019 c 60 art 1 s 47; art 4 s 16 144A.441 ASSISTED LIVING BILL OF RIGHTS ADDENDUM. Assisted living clients, as defined in section 144G.01, subdivision 3, shall be provided with the home care bill of rights required by section 144A.44, except that the home care bill of rights provided to these clients must include the following provision in place of the provision in section 144A.44, subdivision 1, clause (17): "(17) the right to reasonable, advance notice of changes in services or charges, including at least 30 days' advance notice of the termination of a service by a provider, except in cases where: (i) the recipient of services engages in conduct that alters the conditions of employment as specified in the employment contract between the home care provider and the individual providing home care services, or creates an abusive or unsafe work environment for the individual providing home care services; (ii) an emergency for the informal caregiver or a significant change in the recipient's condition has resulted in service needs that exceed the current service provider agreement and that cannot be safely met by the home care provider; or (iii) the provider has not received payment for services, for which at least ten days' advance notice of the termination of a service shall be provided." History: 2006 c 282 art 19 s 1; 2014 c 275 art 1 s 24; 2019 c 60 art 4 s 35 NOTE: This section is repealed by Laws 2019, chapter 60, article 4, section 35, effective August 1, 2021. Laws 2019, chapter 60, article 4, section 35. 144A.442 ASSISTED LIVING CLIENTS; SERVICE TERMINATION. If an arranged home care provider, as defined in section 144D.01, subdivision 2a, who is not also Medicare certified terminates a service agreement or service plan with an assisted living client, as defined in section 144G.01, subdivision 3, the home care provider shall provide the assisted living client and the legal or designated representatives of the client, if any, with a written notice of termination which includes the following information:
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(1) the effective date of termination; (2) the reason for termination; (3) without extending the termination notice period, an affirmative offer to meet with the assisted living client or client representatives within no more than five business days of the date of the termination notice to discuss the termination; (4) contact information for a reasonable number of other home care providers in the geographic area of the assisted living client, as required by section 144A.4791, subdivision 10; (5) a statement that the provider will participate in a coordinated transfer of the care of the client to another provider or caregiver, as required by section 144A.44, subdivision 1, clause (18); (6) the name and contact information of a representative of the home care provider with whom the client may discuss the notice of termination; (7) a copy of the home care bill of rights; and (8) a statement that the notice of termination of home care services by the home care provider does not constitute notice of termination of the housing with services contract with a housing with services establishment. History: 2006 c 282 art 19 s 2; 2014 c 275 art 1 s 25; 2016 c 158 art 1 s 60; 2019 c 60 art 4 s 35 NOTE: This section is repealed by Laws 2019, chapter 60, article 4, section 35, effective August 1, 2021. Laws 2019, chapter 60, article 4, section 35. 144A.45 REGULATION OF HOME CARE SERVICES. Subdivision 1. Regulations. The commissioner shall regulate home care providers pursuant to sections 144A.43 to 144A.482. The regulations shall include the following: (1) provisions to assure, to the extent possible, the health, safety, well-being, and appropriate treatment of persons who receive home care services while respecting a client's autonomy and choice; (2) requirements that home care providers furnish the commissioner with specified information necessary to implement sections 144A.43 to 144A.482; (3) standards of training of home care provider personnel; (4) standards for provision of home care services; (5) standards for medication management; (6) standards for supervision of home care services; (7) standards for client evaluation or assessment; (8) requirements for the involvement of a client's health care provider, the documentation of health care providers' orders, if required, and the client's service plan; (9) the maintenance of accurate, current client records; (10) the establishment of basic and comprehensive levels of licenses based on services provided; and
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144A.47
(11) provisions to enforce these regulations and the home care bill of rights. Subd. 1a. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 1b. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 2. Regulatory functions. The commissioner shall: (1) license, survey, and monitor without advance notice, home care providers in accordance with sections 144A.43 to 144A.482; (2) survey every temporary licensee within one year of the temporary license issuance date subject to the temporary licensee providing home care services to a client or clients; (3) survey all licensed home care providers on an interval that will promote the health and safety of clients; (4) with the consent of the client, visit the home where services are being provided; (5) issue correction orders and assess civil penalties in accordance with section 144.653, subdivisions 5 to 8, for violations of sections 144A.43 to 144A.482; (6) take action as authorized in section 144A.475; and (7) take other action reasonably required to accomplish the purposes of sections 144A.43 to 144A.482. Subd. 3. [Repealed, 1997 c 113 s 22] Subd. 4. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 5. [Repealed by amendment, 2013 c 108 art 11 s 9] Subd. 6. MS 2018 [Repealed, 1Sp2019 c 9 art 11 s 112] History: 1987 c 378 s 5; 1989 c 282 art 2 s 25; 1991 c 286 s 8; 1997 c 113 s 2,3; 1998 c 254 art 1 s 30,31; 2002 c 252 s 5,6,24; 2003 c 37 s 2; 2008 c 326 art 1 s 2,3; 2009 c 174 art 2 s 5,6; 2010 c 246 s 1,2; 2013 c 43 s 16; 2013 c 108 art 11 s 9; 2014 c 275 art 1 s 135 144A.46 [Repealed, 2014 c 275 art 1 s 134] 144A.4605 [Repealed, 2014 c 275 art 1 s 134] 144A.461 [Repealed, 2014 c 275 art 1 s 134] 144A.465 [Repealed, 2014 c 275 art 1 s 134] 144A.47 INFORMATION AND REFERRAL SERVICES. The commissioner shall ensure that information and referral services relating to home care are available in all regions of the state. The commissioner shall collect and make available information about available home care services, sources of payment, providers, and the rights of consumers. The commissioner may require home care providers to provide information requested for the purposes of this section as a condition of registration or licensure. The commissioner may publish and make available: (1) general information describing home care services in the state;
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(2) limitations on hours, availability of services, and eligibility for third-party payments, applicable to individual providers; and (3) other information the commissioner determines to be appropriate. History: 1987 c 378 s 7; 1995 c 207 art 9 s 21 HOME CARE LICENSING 144A.471 HOME CARE PROVIDER AND HOME CARE SERVICES. Subdivision 1. License required. A home care provider may not open, operate, manage, conduct, maintain, or advertise itself as a home care provider or provide home care services in Minnesota without a temporary or current home care provider license issued by the commissioner of health. Subd. 2. Determination of direct home care service. (a) "Direct home care service" means a home care service provided to a client by the home care provider or its employees, and not by contract. Factors that must be considered in determining whether an individual or a business entity provides at least one home care service directly include, but are not limited to, whether the individual or business entity: (1) has the right to control, and does control, the types of services provided; (2) has the right to control, and does control, when and how the services are provided; (3) establishes the charges; (4) collects fees from the clients or receives payment from third-party payers on the clients' behalf; (5) pays individuals providing services compensation on an hourly, weekly, or similar basis; (6) treats the individuals providing services as employees for the purposes of payroll taxes and workers' compensation insurance; and (7) holds itself out as a provider of home care services or acts in a manner that leads clients or potential clients to believe that it is a home care provider providing home care services. (b) None of the factors listed in this subdivision is solely determinative. Subd. 3. Determination of regularly engaged. (a) "Regularly engaged" means providing, or offering to provide, home care services as a regular part of a business. The following factors must be considered by the commissioner in determining whether an individual or a business entity is regularly engaged in providing home care services: (1) whether the individual or business entity states or otherwise promotes that the individual or business entity provides home care services; (2) whether persons receiving home care services constitute a substantial part of the individual's or the business entity's clientele; and (3) whether the home care services provided are other than occasional or incidental to the provision of services other than home care services. (b) None of the factors listed in this subdivision is solely determinative.
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Subd. 4. Penalties for operating without license. A person involved in the management, operation, or control of a home care provider that operates without an appropriate license is guilty of a misdemeanor. This section does not apply to a person who has no legal authority to affect or change decisions related to the management, operation, or control of a home care provider. Subd. 5. Basic and comprehensive levels of licensure. An applicant seeking to become a home care provider must apply for either a basic or comprehensive home care license. Subd. 6. Basic home care license provider. Home care services that can be provided with a basic home care license are assistive tasks provided by licensed or unlicensed personnel that include: (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing; (2) providing standby assistance; (3) providing verbal or visual reminders to the client to take regularly scheduled medication, which includes bringing the client previously set-up medication, medication in original containers, or liquid or food to accompany the medication; (4) providing verbal or visual reminders to the client to perform regularly scheduled treatments and exercises; (5) preparing modified diets ordered by a licensed health professional; and (6) assisting with laundry, housekeeping, meal preparation, shopping, or other household chores and services if the provider is also providing at least one of the activities in clauses (1) to (5). Subd. 7. Comprehensive home care license provider. Home care services that may be provided with a comprehensive home care license include any of the basic home care services listed in subdivision 6, and one or more of the following: (1) services of an advanced practice nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker; (2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person's scope of practice; (3) medication management services; (4) hands-on assistance with transfers and mobility; (5) treatment and therapies; (6) assisting clients with eating when the clients have complicating eating problems as identified in the client record or through an assessment such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be fed; or (7) providing other complex or specialty health care services. Subd. 8. Exemptions from home care services licensure. (a) Except as otherwise provided in this chapter, home care services that are provided by the state, counties, or other units of government must be licensed under this chapter.
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(b) An exemption under this subdivision does not excuse the exempted individual or organization from complying with applicable provisions of the home care bill of rights in section 144A.44. The following individuals or organizations are exempt from the requirement to obtain a home care provider license: (1) an individual or organization that offers, provides, or arranges for personal care assistance services under the medical assistance program as authorized under sections 256B.0625, subdivision 19a, and 256B.0659; (2) a provider that is licensed by the commissioner of human services to provide semi-independent living services for persons with developmental disabilities under section 252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020; (3) a provider that is licensed by the commissioner of human services to provide home and community-based services for persons with developmental disabilities under section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930; (4) an individual or organization that provides only home management services, if the individual or organization is registered under section 144A.482; or (5) an individual who is licensed in this state as a nurse, dietitian, social worker, occupational therapist, physical therapist, or speech-language pathologist who provides health care services in the home independently and not through any contractual or employment relationship with a home care provider or other organization. Subd. 9. Exclusions from home care licensure. The following are excluded from home care licensure and are not required to provide the home care bill of rights: (1) an individual or business entity providing only coordination of home care that includes one or more of the following: (i) determination of whether a client needs home care services, or assisting a client in determining what services are needed; (ii) referral of clients to a home care provider; (iii) administration of payments for home care services; or (iv) administration of a health care home established under section 256B.0751; (2) an individual who is not an employee of a licensed home care provider if the individual: (i) only provides services as an independent contractor to one or more licensed home care providers; (ii) provides no services under direct agreements or contracts with clients; and (iii) is contractually bound to perform services in compliance with the contracting home care provider's policies and service plans; (3) a business that provides staff to home care providers, such as a temporary employment agency, if the business: (i) only provides staff under contract to licensed or exempt providers; (ii) provides no services under direct agreements with clients; and
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(iii) is contractually bound to perform services under the contracting home care provider's direction and supervision; (4) any home care services conducted by and for the adherents of any recognized church or religious denomination for its members through spiritual means, or by prayer for healing; (5) an individual who only provides home care services to a relative; (6) an individual not connected with a home care provider that provides assistance with basic home care needs if the assistance is provided primarily as a contribution and not as a business; (7) an individual not connected with a home care provider that shares housing with and provides primarily housekeeping or homemaking services to an elderly or disabled person in return for free or reduced-cost housing; (8) an individual or provider providing home-delivered meal services; (9) an individual providing senior companion services and other older American volunteer programs (OAVP) established under the Domestic Volunteer Service Act of 1973, United States Code, title 42, chapter 66; (10) an employee of a nursing home or home care provider licensed under this chapter or an employee of a boarding care home licensed under sections 144.50 to 144.56 when responding to occasional emergency calls from individuals residing in a residential setting that is attached to or located on property contiguous to the nursing home, boarding care home, or location where home care services are also provided; (11) an employee of a nursing home or home care provider licensed under this chapter or an employee of a boarding care home licensed under sections 144.50 to 144.56 when providing occasional minor services free of charge to individuals residing in a residential setting that is attached to or located on property contiguous to the nursing home, boarding care home, or location where home care services are also provided; (12) a member of a professional corporation organized under chapter 319B that does not regularly offer or provide home care services as defined in section 144A.43, subdivision 3; (13) the following organizations established to provide medical or surgical services that do not regularly offer or provide home care services as defined in section 144A.43, subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit corporation organized under chapter 317A, a partnership organized under chapter 323, or any other entity determined by the commissioner; (14) an individual or agency that provides medical supplies or durable medical equipment, except when the provision of supplies or equipment is accompanied by a home care service; (15) a physician licensed under chapter 147; (16) an individual who provides home care services to a person with a developmental disability who lives in a place of residence with a family, foster family, or primary caregiver; (17) a business that only provides services that are primarily instructional and not medical services or health-related support services; (18) an individual who performs basic home care services for no more than 14 hours each calendar week to no more than one client;
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(19) an individual or business licensed as hospice as defined in sections 144A.75 to 144A.755 who is not providing home care services independent of hospice service; (20) activities conducted by the commissioner of health or a community health board as defined in section 145A.02, subdivision 5, including communicable disease investigations or testing; or (21) administering or monitoring a prescribed therapy necessary to control or prevent a communicable disease, or the monitoring of an individual's compliance with a health directive as defined in section 144.4172, subdivision 6. [See Note.] History: 2013 c 108 art 11 s 10; 2014 c 262 art 5 s 6; 2014 c 275 art 1 s 135; 2014 c 291 art 7 s 28; 2016 c 179 s 6; 2019 c 60 art 4 s 17,18 NOTE: The amendment to subdivision 9 striking clauses (10) and (11) by Laws 2019, chapter 60, article 4, section 18, is effective July 1, 2021. Laws 2019, chapter 60, article 4, section 18, the effective date. 144A.472 HOME CARE PROVIDER LICENSE; APPLICATION AND RENEWAL. Subdivision 1. License applications. Each application for a home care provider license must include information sufficient to show that the applicant meets the requirements of licensure, including: (1) the applicant's name, e-mail address, physical address, and mailing address, including the name of the county in which the applicant resides and has a principal place of business; (2) the initial license fee in the amount specified in subdivision 7; (3) the e-mail address, physical address, mailing address, and telephone number of the principal administrative office; (4) the e-mail address, physical address, mailing address, and telephone number of each branch office, if any; (5) the names, e-mail and mailing addresses, and telephone numbers of all owners and managerial officials; (6) documentation of compliance with the background study requirements of section 144A.476 for all persons involved in the management, operation, or control of the home care provider; (7) documentation of a background study as required by section 144.057 for any individual seeking employment, paid or volunteer, with the home care provider; (8) evidence of workers' compensation coverage as required by sections 176.181 and 176.182; (9) documentation of liability coverage, if the provider has it; (10) identification of the license level the provider is seeking; (11) documentation that identifies the managerial official who is in charge of day-to-day operations and attestation that the person has reviewed and understands the home care provider regulations; (12) documentation that the applicant has designated one or more owners, managerial officials, or employees as an agent or agents, which shall not affect the legal responsibility of any other owner or managerial official under this chapter;
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(13) the signature of the officer or managing agent on behalf of an entity, corporation, association, or unit of government; (14) verification that the applicant has the following policies and procedures in place so that if a license is issued, the applicant will implement the policies and procedures and keep them current: (i) requirements in sections 626.556, reporting of maltreatment of minors, and 626.557, reporting of maltreatment of vulnerable adults; (ii) conducting and handling background studies on employees; (iii) orientation, training, and competency evaluations of home care staff, and a process for evaluating staff performance; (iv) handling complaints from clients, family members, or client representatives regarding staff or services provided by staff; (v) conducting initial evaluation of clients' needs and the providers' ability to provide those services; (vi) conducting initial and ongoing client evaluations and assessments and how changes in a client's condition are identified, managed, and communicated to staff and other health care providers as appropriate; (vii) orientation to and implementation of the home care client bill of rights; (viii) infection control practices; (ix) reminders for medications, treatments, or exercises, if provided; and (x) conducting appropriate screenings, or documentation of prior screenings, to show that staff are free of tuberculosis, consistent with current United States Centers for Disease Control and Prevention standards; and (15) other information required by the department. Subd. 2. Comprehensive home care license applications. In addition to the information and fee required in subdivision 1, applicants applying for a comprehensive home care license must also provide verification that the applicant has the following policies and procedures in place so that if a license is issued, the applicant will implement the policies and procedures in this subdivision and keep them current: (1) conducting initial and ongoing assessments of the client's needs by a registered nurse or appropriate licensed health professional, including how changes in the client's conditions are identified, managed, and communicated to staff and other health care providers, as appropriate; (2) ensuring that nurses and licensed health professionals have current and valid licenses to practice; (3) medication and treatment management; (4) delegation of home care tasks by registered nurses or licensed health professionals; (5) supervision of registered nurses and licensed health professionals; and (6) supervision of unlicensed personnel performing delegated home care tasks. Subd. 3. License renewal. (a) Except as provided in section 144A.475, a license may be renewed for a period of one year if the licensee satisfies the following:
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(1) submits an application for renewal in the format provided by the commissioner at least 30 days before expiration of the license; (2) submits the renewal fee in the amount specified in subdivision 7; (3) has provided home care services within the past 12 months; (4) complies with sections 144A.43 to 144A.4798; (5) provides information sufficient to show that the applicant meets the requirements of licensure, including items required under subdivision 1; (6) provides verification that all policies under subdivision 1 are current; and (7) provides any other information deemed necessary by the commissioner. (b) A renewal applicant who holds a comprehensive home care license must also provide verification that policies listed under subdivision 2 are current. Subd. 4. MS 2018 [Repealed, 2019 c 60 art 4 s 35] Subd. 5. Changes in ownership. (a) A home care license issued by the commissioner may not be transferred to another party. Before acquiring ownership of or a controlling interest in a home care provider business, a prospective owner must apply for a new license. A change of ownership is a transfer of operational control of the home care provider business and includes: (1) transfer of the business to a different or new corporation; (2) in the case of a partnership, the dissolution or termination of the partnership under chapter 323A, with the business continuing by a successor partnership or other entity; (3) relinquishment of control of the provider to another party, including to a contract management firm that is not under the control of the owner of the business' assets; (4) transfer of the business by a sole proprietor to another party or entity; or (5) transfer of ownership or control of 50 percent or more of the controlling interest of a home care provider business not covered by clauses (1) to (4). (b) An employee who was employed by the previous owner of the home care provider business prior to the effective date of a change in ownership under paragraph (a), and who will be employed by the new owner in the same or a similar capacity, shall be treated as if no change in employer occurred, with respect to orientation, training, tuberculosis testing, background studies, and competency testing and training on the policies identified in subdivision 1, clause (14), and subdivision 2, if applicable. (c) Notwithstanding paragraph (b), a new owner of a home care provider business must ensure that employees of the provider receive and complete training and testing on any provisions of policies that differ from those of the previous owner within 90 days after the date of the change in ownership. Subd. 6. Notification of changes of information. The temporary licensee or licensee shall notify the commissioner in writing within ten working days after any change in the information required in subdivision 1, except the information required in subdivision 1, clause (5), is required at the time of license renewal.
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Subd. 7. Fees; application, change of ownership, renewal, and failure to notify. (a) An initial applicant seeking temporary home care licensure must submit the following application fee to the commissioner along with a completed application: (1) for a basic home care provider, $2,100; or (2) for a comprehensive home care provider, $4,200. (b) A home care provider who is filing a change of ownership as required under subdivision 5 must submit the following application fee to the commissioner, along with the documentation required for the change of ownership: (1) for a basic home care provider, $2,100; or (2) for a comprehensive home care provider, $4,200. (c) For the period ending June 30, 2018, a home care provider who is seeking to renew the provider's license shall pay a fee to the commissioner based on revenues derived from the provision of home care services during the calendar year prior to the year in which the application is submitted, according to the following schedule: License Renewal Fee Provider Annual Revenue
Fee
greater than $1,500,000
$6,625
greater than $1,275,000 and no more than $1,500,000
$5,797
greater than $1,100,000 and no more than $1,275,000
$4,969
greater than $950,000 and no more than $1,100,000
$4,141
greater than $850,000 and no more than $950,000
$3,727
greater than $750,000 and no more than $850,000
$3,313
greater than $650,000 and no more than $750,000
$2,898
greater than $550,000 and no more than $650,000
$2,485
greater than $450,000 and no more than $550,000
$2,070
greater than $350,000 and no more than $450,000
$1,656
greater than $250,000 and no more than $350,000
$1,242
greater than $100,000 and no more than $250,000
$828
greater than $50,000 and no more than $100,000
$500
greater than $25,000 and no more than $50,000
$400
no more than $25,000
$200
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(d) For the period between July 1, 2018, and June 30, 2020, a home care provider who is seeking to renew the provider's license shall pay a fee to the commissioner in an amount that is ten percent higher than the applicable fee in paragraph (c). A home care provider's fee shall be based on revenues derived from the provision of home care services during the calendar year prior to the year in which the application is submitted. (e) Beginning July 1, 2020, a home care provider who is seeking to renew the provider's license shall pay a fee to the commissioner based on revenues derived from the provision of home care services during the calendar year prior to the year in which the application is submitted, according to the following schedule: License Renewal Fee Provider Annual Revenue
Fee
greater than $1,500,000
$7,651
greater than $1,275,000 and no more than $1,500,000
$6,695
greater than $1,100,000 and no more than $1,275,000
$5,739
greater than $950,000 and no more than $1,100,000
$4,783
greater than $850,000 and no more than $950,000
$4,304
greater than $750,000 and no more than $850,000
$3,826
greater than $650,000 and no more than $750,000
$3,347
greater than $550,000 and no more than $650,000
$2,870
greater than $450,000 and no more than $550,000
$2,391
greater than $350,000 and no more than $450,000
$1,913
greater than $250,000 and no more than $350,000
$1,434
greater than $100,000 and no more than $250,000
$957
greater than $50,000 and no more than $100,000
$577
greater than $25,000 and no more than $50,000
$462
no more than $25,000
$231
(f) If requested, the home care provider shall provide the commissioner information to verify the provider's annual revenues or other information as needed, including copies of documents submitted to the Department of Revenue. (g) At each annual renewal, a home care provider may elect to pay the highest renewal fee for its license category, and not provide annual revenue information to the commissioner. (h) A temporary license or license applicant, or temporary licensee or licensee that knowingly provides the commissioner incorrect revenue amounts for the purpose of paying a lower license fee, shall be subject to a civil penalty in the amount of double the fee the provider should have paid.
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(i) The fine for failure to comply with the notification requirements in section 144A.473, subdivision 2, paragraph (c), is $1,000. (j) Fees collected under this section shall be deposited in the state treasury and credited to the state government special revenue fund. All fees are nonrefundable. Fees collected under paragraphs (c), (d), and (e) are nonrefundable even if received before July 1, 2017, for temporary licenses or licenses being issued effective July 1, 2017, or later. (k) Fines and civil penalties collected under this subdivision shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner to implement the recommendations of the advisory council established in section 144A.4799. History: 2013 c 108 art 11 s 11; 2014 c 275 art 1 s 135; 1Sp2017 c 6 art 10 s 68; 2019 c 60 art 4 s 19; 1Sp2019 c 9 art 11 s 41,42 144A.473 ISSUANCE OF TEMPORARY LICENSE AND LICENSE RENEWAL. Subdivision 1. Temporary license and renewal of license. (a) The department shall review each application to determine the applicant's knowledge of and compliance with Minnesota home care regulations. Before granting a temporary license or renewing a license, the commissioner may further evaluate the applicant or licensee by requesting additional information or documentation or by conducting an on-site survey of the applicant to determine compliance with sections 144A.43 to 144A.482. (b) Within 14 calendar days after receiving an application for a license, the commissioner shall acknowledge receipt of the application in writing. The acknowledgment must indicate whether the application appears to be complete or whether additional information is required before the application will be considered complete. (c) Within 90 days after receiving a complete application, the commissioner shall issue a temporary license, renew the license, or deny the license. (d) The commissioner shall issue a license that contains the home care provider's name, address, license level, expiration date of the license, and unique license number. All licenses, except for temporary licenses issued under subdivision 2, are valid for up to one year from the date of issuance. Subd. 2. Temporary license. (a) For new license applicants, the commissioner shall issue a temporary license for either the basic or comprehensive home care level. A temporary license is effective for up to one year from the date of issuance, except that a temporary license may be extended according to subdivision 3. Temporary licensees must comply with sections 144A.43 to 144A.482. (b) During the temporary license period, the commissioner shall survey the temporary licensee within 90 calendar days after the commissioner is notified or has evidence that the temporary licensee is providing home care services. (c) Within five days of beginning the provision of services, the temporary licensee must notify the commissioner that it is serving clients. The notification to the commissioner may be mailed or e-mailed to the commissioner at the address provided by the commissioner. If the temporary licensee does not provide home care services during the temporary license period, then the temporary license expires at the end of the period and the applicant must reapply for a temporary home care license. (d) A temporary licensee may request a change in the level of licensure prior to being surveyed and granted a license by notifying the commissioner in writing and providing additional documentation or
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materials required to update or complete the changed temporary license application. The applicant must pay the difference between the application fees when changing from the basic level to the comprehensive level of licensure. No refund will be made if the provider chooses to change the license application to the basic level. (e) If the temporary licensee notifies the commissioner that the licensee has clients within 45 days prior to the temporary license expiration, the commissioner may extend the temporary license for up to 60 days in order to allow the commissioner to complete the on-site survey required under this section and follow-up survey visits. Subd. 3. Temporary licensee survey. (a) If the temporary licensee is in substantial compliance with the survey, the commissioner shall issue either a basic or comprehensive home care license. If the temporary licensee is not in substantial compliance with the survey, the commissioner shall either: (1) not issue a license and terminate the temporary license; or (2) extend the temporary license for a period not to exceed 90 days and apply conditions, as permitted under section 144A.475, subdivision 2, to the extension of a temporary license. If the temporary licensee is not in substantial compliance with the survey within the time period of the extension, or if the temporary licensee does not satisfy the license conditions, the commissioner may deny the license. (b) If the temporary licensee whose basic or comprehensive license has been denied or extended with conditions disagrees with the conclusions of the commissioner, then the temporary licensee may request a reconsideration by the commissioner or commissioner's designee. The reconsideration request process must be conducted internally by the commissioner or commissioner's designee, and chapter 14 does not apply. (c) The temporary licensee requesting reconsideration must make the request in writing and must list and describe the reasons why the temporary licensee disagrees with the decision to deny the basic or comprehensive home care license or the decision to extend the temporary license with conditions. (d) The reconsideration request and supporting documentation must be received by the commissioner within 15 calendar days after the date the temporary licensee receives the correction order. (e) A temporary licensee whose license is denied is permitted to continue operating as a home care provider during the period of time when: (1) a reconsideration request is in process; (2) an extension of a temporary license is being negotiated; (3) the placement of conditions on a temporary license is being negotiated; or (4) a transfer of home care clients from the temporary licensee to a new home care provider is in process. (f) A temporary licensee whose license is denied must comply with the requirements for notification and transfer of clients in section 144A.475, subdivision 5. History: 2013 c 108 art 11 s 12; 2014 c 275 art 1 s 135; 2016 c 179 s 7; 1Sp2019 c 9 art 11 s 43 144A.474 SURVEYS AND INVESTIGATIONS. Subdivision 1. Surveys. The commissioner shall conduct surveys of each home care provider. By June 30, 2016, the commissioner shall conduct a survey of home care providers on a frequency of at least once every three years. Survey frequency may be based on the license level, the provider's compliance history,
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the number of clients served, or other factors as determined by the department deemed necessary to ensure the health, safety, and welfare of clients and compliance with the law. Subd. 2. Types of home care surveys. (a) "Initial full survey" means the survey of a new temporary licensee conducted after the department is notified or has evidence that the temporary licensee is providing home care services to determine if the provider is in compliance with home care requirements. Initial full surveys must be completed within 14 months after the department's issuance of a temporary basic or comprehensive license. (b) "Change in ownership survey" means a full survey of a new licensee due to a change in ownership. Change in ownership surveys must be completed within six months after the department's issuance of a new license due to a change in ownership. (c) "Core survey" means periodic inspection of home care providers to determine ongoing compliance with the home care requirements, focusing on the essential health and safety requirements. Core surveys are available to licensed home care providers who have been licensed for three years and surveyed at least once in the past three years with the latest survey having no widespread violations beyond Level 1 as provided in subdivision 11. Providers must also not have had any substantiated licensing complaints, substantiated complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors Act, or an enforcement action as authorized in section 144A.475 in the past three years. (1) The core survey for basic home care providers must review compliance in the following areas: (i) reporting of maltreatment; (ii) orientation to and implementation of the home care bill of rights; (iii) statement of home care services; (iv) initial evaluation of clients and initiation of services; (v) client review and monitoring; (vi) service plan implementation and changes to the service plan; (vii) client complaint and investigative process; (viii) competency of unlicensed personnel; and (ix) infection control. (2) For comprehensive home care providers, the core survey must include everything in the basic core survey plus these areas: (i) delegation to unlicensed personnel; (ii) assessment, monitoring, and reassessment of clients; and (iii) medication, treatment, and therapy management. (d) "Full survey" means the periodic inspection of home care providers to determine ongoing compliance with the home care requirements that cover the core survey areas and all the legal requirements for home care providers. A full survey is conducted for all temporary licensees, for licensees that receive licenses due to an approved change in ownership, for providers who do not meet the requirements needed for a core survey, and when a surveyor identifies unacceptable client health or safety risks during a core survey. A full
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survey must include all the tasks identified as part of the core survey and any additional review deemed necessary by the department, including additional observation, interviewing, or records review of additional clients and staff. (e) "Follow-up surveys" means surveys conducted to determine if a home care provider has corrected deficient issues and systems identified during a core survey, full survey, or complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be concluded with an exit conference and written information provided on the process for requesting a reconsideration of the survey results. (f) Upon receiving information alleging that a home care provider has violated or is currently violating a requirement of sections 144A.43 to 144A.482, the commissioner shall investigate the complaint according to sections 144A.51 to 144A.54. Subd. 3. Survey process. The survey process for core surveys shall include the following as applicable to the particular licensee and setting surveyed: (1) presurvey review of pertinent documents and notification to the ombudsman for long-term care; (2) an entrance conference with available staff; (3) communication with managerial officials or the registered nurse in charge, if available, and ongoing communication with key staff throughout the survey regarding information needed by the surveyor, clarifications regarding home care requirements, and applicable standards of practice; (4) presentation of written contact information to the provider about the survey staff conducting the survey, the supervisor, and the process for requesting a reconsideration of the survey results; (5) a brief tour of a sample of the housing with services establishments in which the provider is providing home care services; (6) a sample selection of home care clients; (7) information-gathering through client and staff observations, client and staff interviews, and reviews of records, policies, procedures, practices, and other agency information; (8) interviews of clients' family members, if available, with clients' consent when the client can legally give consent; (9) except for complaint surveys conducted by the Office of Health Facilities Complaints, an on-site exit conference, with preliminary findings shared and discussed with the provider, documentation that an exit conference occurred, and written information provided on the process for requesting a reconsideration of the survey results; and (10) postsurvey analysis of findings and formulation of survey results, including correction orders when applicable. Subd. 4. Scheduling surveys. Surveys and investigations shall be conducted without advance notice to home care providers. Surveyors may contact the home care provider on the day of a survey to arrange for someone to be available at the survey site. The contact does not constitute advance notice. Subd. 5. Information provided by home care provider. The home care provider shall provide accurate and truthful information to the department during a survey, investigation, or other licensing activities.
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Subd. 6. Providing client records. Upon request of a surveyor, home care providers shall provide a list of current and past clients or client representatives that includes addresses and telephone numbers and any other information requested about the services to clients within a reasonable period of time. Subd. 7. Contacting and visiting clients. Surveyors may contact or visit a home care provider's clients to gather information without notice to the home care provider. Before visiting a client, a surveyor shall obtain the client's or client's representative's permission by telephone, by mail, or in person. Surveyors shall inform all clients or client's representatives of their right to decline permission for a visit. Subd. 8. Correction orders. (a) A correction order may be issued whenever the commissioner finds upon survey or during a complaint investigation that a home care provider, a managerial official, or an employee of the provider is not in compliance with sections 144A.43 to 144A.482. The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction. (b) The commissioner shall mail copies of any correction order to the last known address of the home care provider, or electronically scan the correction order and e-mail it to the last known home care provider e-mail address, within 30 calendar days after the survey exit date. A copy of each correction order and copies of any documentation supplied to the commissioner shall be kept on file by the home care provider, and public documents shall be made available for viewing by any person upon request. Copies may be kept electronically. (c) By the correction order date, the home care provider must document in the provider's records any action taken to comply with the correction order. The commissioner may request a copy of this documentation and the home care provider's action to respond to the correction order in future surveys, upon a complaint investigation, and as otherwise needed. Subd. 9. Follow-up surveys. For providers that have Level 3 or Level 4 violations under subdivision 11, or any violations determined to be widespread, the department shall conduct a follow-up survey within 90 calendar days of the survey. When conducting a follow-up survey, the surveyor will focus on whether the previous violations have been corrected and may also address any new violations that are observed while evaluating the corrections that have been made. Subd. 10. Performance incentive. A licensee is eligible for a performance incentive if there are no violations identified in a core or full survey. The performance incentive is a ten percent discount on the licensee's next home care renewal license fee. Subd. 11. Fines. (a) Fines and enforcement actions under this subdivision may be assessed based on the level and scope of the violations described in paragraph (b) and imposed immediately with no opportunity to correct the violation first as follows: (1) Level 1, no fines or enforcement; (2) Level 2, a fine of $500 per violation, in addition to any of the enforcement mechanisms authorized in section 144A.475 for widespread violations; (3) Level 3, a fine of $3,000 per incident, in addition to any of the enforcement mechanisms authorized in section 144A.475; (4) Level 4, a fine of $5,000 per incident, in addition to any of the enforcement mechanisms authorized in section 144A.475;
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(5) for maltreatment violations for which the licensee was determined to be responsible for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000. A fine of $5,000 may be imposed if the commissioner determines the licensee is responsible for maltreatment consisting of sexual assault, death, or abuse resulting in serious injury; and (6) the fines in clauses (1) to (4) are increased and immediate fine imposition is authorized for both surveys and investigations conducted. When a fine is assessed against a facility for substantiated maltreatment, the commissioner shall not also impose an immediate fine under this chapter for the same circumstance. (b) Correction orders for violations are categorized by both level and scope and fines shall be assessed as follows: (1) level of violation: (i) Level 1 is a violation that has no potential to cause more than a minimal impact on the client and does not affect health or safety; (ii) Level 2 is a violation that did not harm a client's health or safety but had the potential to have harmed a client's health or safety, but was not likely to cause serious injury, impairment, or death; (iii) Level 3 is a violation that harmed a client's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death; and (iv) Level 4 is a violation that results in serious injury, impairment, or death; (2) scope of violation: (i) isolated, when one or a limited number of clients are affected or one or a limited number of staff are involved or the situation has occurred only occasionally; (ii) pattern, when more than a limited number of clients are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly but is not found to be pervasive; and (iii) widespread, when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the clients. (c) If the commissioner finds that the applicant or a home care provider has not corrected violations by the date specified in the correction order or conditional license resulting from a survey or complaint investigation, the commissioner shall provide a notice of noncompliance with a correction order by e-mail to the applicant's or provider's last known e-mail address. The noncompliance notice must list the violations not corrected. (d) For every violation identified by the commissioner, the commissioner shall issue an immediate fine pursuant to paragraph (a), clause (6). The license holder must still correct the violation in the time specified. The issuance of an immediate fine can occur in addition to any enforcement mechanism authorized under section 144A.475. The immediate fine may be appealed as allowed under this subdivision. (e) The license holder must pay the fines assessed on or before the payment date specified. If the license holder fails to fully comply with the order, the commissioner may issue a second fine or suspend the license until the license holder complies by paying the fine. A timely appeal shall stay payment of the fine until the commissioner issues a final order.
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(f) A license holder shall promptly notify the commissioner in writing when a violation specified in the order is corrected. If upon reinspection the commissioner determines that a violation has not been corrected as indicated by the order, the commissioner may issue a second fine. The commissioner shall notify the license holder by mail to the last known address in the licensing record that a second fine has been assessed. The license holder may appeal the second fine as provided under this subdivision. (g) A home care provider that has been assessed a fine under this subdivision has a right to a reconsideration or a hearing under this section and chapter 14. (h) When a fine has been assessed, the license holder may not avoid payment by closing, selling, or otherwise transferring the licensed program to a third party. In such an event, the license holder shall be liable for payment of the fine. (i) In addition to any fine imposed under this section, the commissioner may assess a penalty amount based on costs related to an investigation that results in a final order assessing a fine or other enforcement action authorized by this chapter. (j) Fines collected under paragraph (a), clauses (1) to (4), shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner to implement the recommendations of the advisory council established in section 144A.4799. (k) Fines collected under paragraph (a), clause (5), shall be deposited in a dedicated special revenue account and appropriated to the commissioner to provide compensation according to subdivision 14 to clients subject to maltreatment. A client may choose to receive compensation from this fund, not to exceed $5,000 for each substantiated finding of maltreatment, or take civil action. This paragraph expires July 31, 2021. Subd. 12. Reconsideration. (a) The commissioner shall make available to home care providers a correction order reconsideration process. This process may be used to challenge the correction order issued, including the level and scope described in subdivision 11, and any fine assessed. During the correction order reconsideration request, the issuance for the correction orders under reconsideration are not stayed, but the department shall post information on the website with the correction order that the licensee has requested a reconsideration and that the review is pending. (b) A licensed home care provider may request from the commissioner, in writing, a correction order reconsideration regarding any correction order issued to the provider. The written request for reconsideration must be received by the commissioner within 15 calendar days of the correction order receipt date. The correction order reconsideration shall not be reviewed by any surveyor, investigator, or supervisor that participated in the writing or reviewing of the correction order being disputed. The correction order reconsiderations may be conducted in person, by telephone, by another electronic form, or in writing, as determined by the commissioner. The commissioner shall respond in writing to the request from a home care provider for a correction order reconsideration within 60 days of the date the provider requests a reconsideration. The commissioner's response shall identify the commissioner's decision regarding each citation challenged by the home care provider. (c) The findings of a correction order reconsideration process shall be one or more of the following: (1) supported in full, the correction order is supported in full, with no deletion of findings to the citation; (2) supported in substance, the correction order is supported, but one or more findings are deleted or modified without any change in the citation;
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(3) correction order cited an incorrect home care licensing requirement, the correction order is amended by changing the correction order to the appropriate statutory reference; (4) correction order was issued under an incorrect citation, the correction order is amended to be issued under the more appropriate correction order citation; (5) the correction order is rescinded; (6) fine is amended, it is determined that the fine assigned to the correction order was applied incorrectly; or (7) the level or scope of the citation is modified based on the reconsideration. (d) If the correction order findings are changed by the commissioner, the commissioner shall update the correction order website. (e) This subdivision does not apply to temporary licensees. Subd. 13. Home care surveyor training. (a) Before conducting a home care survey, each home care surveyor must receive training on the following topics: (1) Minnesota home care licensure requirements; (2) Minnesota home care bill of rights; (3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors; (4) principles of documentation; (5) survey protocol and processes; (6) Offices of the Ombudsman roles; (7) Office of Health Facility Complaints; (8) Minnesota landlord-tenant and housing with services laws; (9) types of payors for home care services; and (10) Minnesota Nurse Practice Act for nurse surveyors. (b) Materials used for the training in paragraph (a) shall be posted on the department website. Requisite understanding of these topics will be reviewed as part of the quality improvement plan in section 144A.483. Subd. 14. Maltreatment compensation fund. (a) Once a finding of maltreatment for which the licensee is determined to be responsible is substantiated and any request for reconsideration, if applicable, is completed, the commissioner shall pay the fine assessed under subdivision 11, paragraph (a), clause (5), as compensation to the client who was subject to the maltreatment, if: (1) the client chooses to receive a compensation payment of either $1,000 or $5,000 as determined by the fine assessed under subdivision 11, paragraph (a), clause (5), depending on the level of maltreatment; and (2) the client accepts payment of compensation under this subdivision as payment in full and agrees to waive any civil claims, including claims under section 626.557, subdivision 20, arising from the specific maltreatment incident that resulted in the fine.
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(b) The commissioner shall notify the client that the client may reject a compensation payment under this subdivision and instead pursue any civil claims. (c) Except as provided in paragraph (a), nothing in this subdivision affects the rights available to clients under section 626.557 or prevents a client from filing a maltreatment report in the future. (d) This subdivision expires July 31, 2021. History: 2013 c 108 art 11 s 13; 2014 c 275 art 1 s 135; 2014 c 291 art 6 s 13,14; 1Sp2017 c 6 art 10 s 69; 2019 c 60 art 4 s 20-22; 1Sp2019 c 9 art 11 s 44 144A.475 ENFORCEMENT. Subdivision 1. Conditions. (a) The commissioner may refuse to grant a temporary license, refuse to grant a license as a result of a change in ownership, refuse to renew a license, suspend or revoke a license, or impose a conditional license if the home care provider or owner or managerial official of the home care provider: (1) is in violation of, or during the term of the license has violated, any of the requirements in sections 144A.471 to 144A.482; (2) permits, aids, or abets the commission of any illegal act in the provision of home care; (3) performs any act detrimental to the health, safety, and welfare of a client; (4) obtains the license by fraud or misrepresentation; (5) knowingly made or makes a false statement of a material fact in the application for a license or in any other record or report required by this chapter; (6) denies representatives of the department access to any part of the home care provider's books, records, files, or employees; (7) interferes with or impedes a representative of the department in contacting the home care provider's clients; (8) interferes with or impedes a representative of the department in the enforcement of this chapter or has failed to fully cooperate with an inspection, survey, or investigation by the department; (9) destroys or makes unavailable any records or other evidence relating to the home care provider's compliance with this chapter; (10) refuses to initiate a background study under section 144.057 or 245A.04; (11) fails to timely pay any fines assessed by the department; (12) violates any local, city, or township ordinance relating to home care services; (13) has repeated incidents of personnel performing services beyond their competency level; or (14) has operated beyond the scope of the home care provider's license level. (b) A violation by a contractor providing the home care services of the home care provider is a violation by the home care provider.
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Subd. 2. Terms to suspension or conditional license. (a) A suspension or conditional license designation may include terms that must be completed or met before a suspension or conditional license designation is lifted. A conditional license designation may include restrictions or conditions that are imposed on the provider. Terms for a suspension or conditional license may include one or more of the following and the scope of each will be determined by the commissioner: (1) requiring a consultant to review, evaluate, and make recommended changes to the home care provider's practices and submit reports to the commissioner at the cost of the home care provider; (2) requiring supervision of the home care provider or staff practices at the cost of the home care provider by an unrelated person who has sufficient knowledge and qualifications to oversee the practices and who will submit reports to the commissioner; (3) requiring the home care provider or employees to obtain training at the cost of the home care provider; (4) requiring the home care provider to submit reports to the commissioner; (5) prohibiting the home care provider from taking any new clients for a period of time; or (6) any other action reasonably required to accomplish the purpose of this subdivision and section 144A.45, subdivision 2. (b) A home care provider subject to this subdivision may continue operating during the period of time home care clients are being transferred to other providers. Subd. 3. Notice. (a) Prior to any suspension, revocation, or refusal to renew a license, the home care provider shall be entitled to notice and a hearing as provided by sections 14.57 to 14.69. In addition to any other remedy provided by law, the commissioner may, without a prior contested case hearing, temporarily suspend a license or prohibit delivery of services by a provider for not more than 90 days, or issue a conditional license if the commissioner determines that there are level 3 violations that do not pose an imminent risk of harm to the health or safety of persons in the provider's care, provided: (1) advance notice is given to the home care provider; (2) after notice, the home care provider fails to correct the problem; (3) the commissioner has reason to believe that other administrative remedies are not likely to be effective; and (4) there is an opportunity for a contested case hearing within the 30 days unless there is an extension granted by an administrative law judge pursuant to subdivision 3b. (b) If the commissioner determines there are: (1) level 4 violations; or (2) violations that pose an imminent risk of harm to the health or safety of persons in the provider's care, the commissioner may immediately temporarily suspend a license, prohibit delivery of services by a provider, or issue a conditional license without meeting the requirements of paragraph (a), clauses (1) to (4). For the purposes of this subdivision, "level 3" and "level 4" have the meanings given in section 144A.474, subdivision 11, paragraph (b).
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Subd. 3a. Hearing. Within 15 business days of receipt of the licensee's timely appeal of a sanction under this section, other than for a temporary suspension, the commissioner shall request assignment of an administrative law judge. The commissioner's request must include a proposed date, time, and place of hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 90 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause or for purposes of discussing settlement. In no case shall one or more extensions be granted for a total of more than 90 calendar days unless there is a criminal action pending against the licensee. If, while a licensee continues to operate pending an appeal of an order for revocation, suspension, or refusal to renew a license, the commissioner identifies one or more new violations of law that meet the requirements of level 3 or 4 violations as defined in section 144A.474, subdivision 11, paragraph (b), the commissioner shall act immediately to temporarily suspend the license under the provisions in subdivision 3. Subd. 3b. Expedited hearing. (a) Within five business days of receipt of the license holder's timely appeal of a temporary suspension or issuance of a conditional license, the commissioner shall request assignment of an administrative law judge. The request must include a proposed date, time, and place of a hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 30 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause. The commissioner shall issue a notice of hearing by certified mail or personal service at least ten business days before the hearing. Certified mail to the last known address is sufficient. The scope of the hearing shall be limited solely to the issue of whether the temporary suspension or issuance of a conditional license should remain in effect and whether there is sufficient evidence to conclude that the licensee's actions or failure to comply with applicable laws are level 3 or 4 violations as defined in section 144A.474, subdivision 11, paragraph (b), or that there were violations that posed an imminent risk of harm to the health and safety of persons in the provider's care. (b) The administrative law judge shall issue findings of fact, conclusions, and a recommendation within ten business days from the date of hearing. The parties shall have ten calendar days to submit exceptions to the administrative law judge's report. The record shall close at the end of the ten-day period for submission of exceptions. The commissioner's final order shall be issued within ten business days from the close of the record. When an appeal of a temporary immediate suspension or conditional license is withdrawn or dismissed, the commissioner shall issue a final order affirming the temporary immediate suspension or conditional license within ten calendar days of the commissioner's receipt of the withdrawal or dismissal. The license holder is prohibited from operation during the temporary suspension period. (c) When the final order under paragraph (b) affirms an immediate suspension, and a final licensing sanction is issued under subdivisions 1 and 2 and the licensee appeals that sanction, the licensee is prohibited from operation pending a final commissioner's order after the contested case hearing conducted under chapter 14. (d) A licensee whose license is temporarily suspended must comply with the requirements for notification and transfer of clients in subdivision 5. These requirements remain if an appeal is requested. Subd. 3c. Immediate temporary suspension. (a) In addition to any other remedies provided by law, the commissioner may, without a prior contested case hearing, immediately temporarily suspend a license or prohibit delivery of services by a provider for not more than 90 days, or issue a conditional license, if the commissioner determines that there are: (1) level 4 violations; or
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(2) violations that pose an imminent risk of harm to the health or safety of persons in the provider's care. (b) For purposes of this subdivision, "level 4" has the meaning given in section 144A.474, subdivision 11, paragraph (b). (c) A notice stating the reasons for the immediate temporary suspension or conditional license and informing the license holder of the right to an expedited hearing under subdivision 3b must be delivered by personal service to the address shown on the application or the last known address of the license holder. The license holder may appeal an order immediately temporarily suspending a license or issuing a conditional license. The appeal must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the commissioner within five calendar days after the license holder receives notice. If an appeal is made by personal service, it must be received by the commissioner within five calendar days after the license holder received the order. (d) A license holder whose license is immediately temporarily suspended must comply with the requirements for notification and transfer of clients in subdivision 5. These requirements remain if an appeal is requested. Subd. 4. Time limits for appeals. To appeal the assessment of civil penalties under section 144A.45, subdivision 2, clause (5), and an action against a license under this section, a provider must request a hearing no later than 15 days after the provider receives notice of the action. Subd. 5. Plan required. (a) The process of suspending, revoking, or refusing to renew a license must include a plan for transferring affected clients' care to other providers by the home care provider, which will be monitored by the commissioner. Within three calendar days of being notified of the revocation, refusal to renew, or suspension, the home care provider shall provide the commissioner, the lead agencies as defined in section 256B.0911, county adult protection and case managers, and the ombudsman for long-term care with the following information: (1) a list of all clients, including full names and all contact information on file; (2) a list of each client's representative or emergency contact person, including full names and all contact information on file; (3) the location or current residence of each client; (4) the payor sources for each client, including payor source identification numbers; and (5) for each client, a copy of the client's service plan, and a list of the types of services being provided. (b) The revocation, refusal to renew, or suspension notification requirement is satisfied by mailing the notice to the address in the license record. The home care provider shall cooperate with the commissioner and the lead agencies, county adult protection and case managers, and the ombudsman for long-term care during the process of transferring care of clients to qualified providers. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension action, the home care provider must notify and disclose to each of the home care provider's clients, or the client's representative or emergency contact persons, that the commissioner is taking action against the home care provider's license by providing a copy of the revocation, refusal to renew, or suspension notice issued by the commissioner. If the provider does not comply with the disclosure requirements in this section, the commissioner shall notify the clients, client representatives, or emergency contact persons about the action being taken. Lead agencies, county adult protection and case managers, and the Office of Ombudsman for Long-Term Care may also provide this
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information. The revocation, refusal to renew, or suspension notice is public data except for any private data contained therein. (c) A home care provider subject to this subdivision may continue operating during the period of time home care clients are being transferred to other providers. Subd. 6. Owners and managerial officials; refusal to grant license. (a) The owner and managerial officials of a home care provider whose Minnesota license has not been renewed or that has been revoked because of noncompliance with applicable laws or rules shall not be eligible to apply for nor will be granted a home care license, including other licenses under this chapter, or be given status as an enrolled personal care assistance provider agency or personal care assistant by the Department of Human Services under section 256B.0659 for five years following the effective date of the nonrenewal or revocation. If the owner and managerial officials already have enrollment status, their enrollment will be terminated by the Department of Human Services. (b) The commissioner shall not issue a license to a home care provider for five years following the effective date of license nonrenewal or revocation if the owner or managerial official, including any individual who was an owner or managerial official of another home care provider, had a Minnesota license that was not renewed or was revoked as described in paragraph (a). (c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall suspend or revoke, the license of any home care provider that includes any individual as an owner or managerial official who was an owner or managerial official of a home care provider whose Minnesota license was not renewed or was revoked as described in paragraph (a) for five years following the effective date of the nonrenewal or revocation. (d) The commissioner shall notify the home care provider 30 days in advance of the date of nonrenewal, suspension, or revocation of the license. Within ten days after the receipt of the notification, the home care provider may request, in writing, that the commissioner stay the nonrenewal, revocation, or suspension of the license. The home care provider shall specify the reasons for requesting the stay; the steps that will be taken to attain or maintain compliance with the licensure laws and regulations; any limits on the authority or responsibility of the owners or managerial officials whose actions resulted in the notice of nonrenewal, revocation, or suspension; and any other information to establish that the continuing affiliation with these individuals will not jeopardize client health, safety, or well-being. The commissioner shall determine whether the stay will be granted within 30 days of receiving the provider's request. The commissioner may propose additional restrictions or limitations on the provider's license and require that the granting of the stay be contingent upon compliance with those provisions. The commissioner shall take into consideration the following factors when determining whether the stay should be granted: (1) the threat that continued involvement of the owners and managerial officials with the home care provider poses to client health, safety, and well-being; (2) the compliance history of the home care provider; and (3) the appropriateness of any limits suggested by the home care provider. If the commissioner grants the stay, the order shall include any restrictions or limitation on the provider's license. The failure of the provider to comply with any restrictions or limitations shall result in the immediate removal of the stay and the commissioner shall take immediate action to suspend, revoke, or not renew the license. Subd. 7. Request for hearing. A request for a hearing must be in writing and must:
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(1) be mailed or delivered to the department or the commissioner's designee; (2) contain a brief and plain statement describing every matter or issue contested; and (3) contain a brief and plain statement of any new matter that the applicant or home care provider believes constitutes a defense or mitigating factor. Subd. 8. Informal conference. At any time, the applicant or home care provider and the commissioner may hold an informal conference to exchange information, clarify issues, or resolve issues. Subd. 9. Injunctive relief. In addition to any other remedy provided by law, the commissioner may bring an action in district court to enjoin a person who is involved in the management, operation, or control of a home care provider or an employee of the home care provider from illegally engaging in activities regulated by sections 144A.43 to 144A.482. The commissioner may bring an action under this subdivision in the district court in Ramsey County or in the district in which a home care provider is providing services. The court may grant a temporary restraining order in the proceeding if continued activity by the person who is involved in the management, operation, or control of a home care provider, or by an employee of the home care provider, would create an imminent risk of harm to a recipient of home care services. Subd. 10. Subpoena. In matters pending before the commissioner under sections 144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance of witnesses and the production of all necessary papers, books, records, documents, and other evidentiary material. If a person fails or refuses to comply with a subpoena or order of the commissioner to appear or testify regarding any matter about which the person may be lawfully questioned or to produce any papers, books, records, documents, or evidentiary materials in the matter to be heard, the commissioner may apply to the district court in any district, and the court shall order the person to comply with the commissioner's order or subpoena. The commissioner of health may administer oaths to witnesses or take their affirmation. Depositions may be taken in or outside the state in the manner provided by law for the taking of depositions in civil actions. A subpoena or other process or paper may be served on a named person anywhere in the state by an officer authorized to serve subpoenas in civil actions, with the same fees and mileage and in the same manner as prescribed by law for a process issued out of a district court. A person subpoenaed under this subdivision shall receive the same fees, mileage, and other costs that are paid in proceedings in district court. History: 2013 c 108 art 11 s 14; 2014 c 275 art 1 s 135; 2014 c 291 art 6 s 15-17; 2016 c 179 s 8-10; 2019 c 60 art 4 s 23,24; 1Sp2019 c 9 art 11 s 45-47 144A.476 BACKGROUND STUDIES. Subdivision 1. Prior criminal convictions; owner and managerial officials. (a) Before the commissioner issues a temporary license, issues a license as a result of an approved change in ownership, or renews a license, an owner or managerial official is required to complete a background study under section 144.057. No person may be involved in the management, operation, or control of a home care provider if the person has been disqualified under chapter 245C. If an individual is disqualified under section 144.057 or chapter 245C, the individual may request reconsideration of the disqualification. If the individual requests reconsideration and the commissioner sets aside or rescinds the disqualification, the individual is eligible to be involved in the management, operation, or control of the provider. If an individual has a disqualification under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's disqualification is barred from a set aside, and the individual must not be involved in the management, operation, or control of the provider.
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(b) For purposes of this section, owners of a home care provider subject to the background check requirement are those individuals whose ownership interest provides sufficient authority or control to affect or change decisions related to the operation of the home care provider. An owner includes a sole proprietor, a general partner, or any other individual whose individual ownership interest can affect the management and direction of the policies of the home care provider. (c) For the purposes of this section, managerial officials subject to the background check requirement are individuals who provide direct contact as defined in section 245C.02, subdivision 11, or individuals who have the responsibility for the ongoing management or direction of the policies, services, or employees of the home care provider. Data collected under this subdivision shall be classified as private data on individuals under section 13.02, subdivision 12. (d) The department shall not issue any license if the applicant or owner or managerial official has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C; if the owner or managerial official, as an owner or managerial official of another home care provider, was substantially responsible for the other home care provider's failure to substantially comply with sections 144A.43 to 144A.482; or if an owner that has ceased doing business, either individually or as an owner of a home care provider, was issued a correction order for failing to assist clients in violation of this chapter. Subd. 2. Employees, contractors, and volunteers. (a) Employees, contractors, and volunteers of a home care provider are subject to the background study required by section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall be construed to prohibit a home care provider from requiring self-disclosure of criminal conviction information. (b) Termination of an employee in good faith reliance on information or records obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not subject the home care provider to civil liability or liability for unemployment benefits. History: 2013 c 108 art 11 s 15; 2014 c 275 art 1 s 135; 2019 c 60 art 4 s 25; 1Sp2019 c 9 art 11 s 48 144A.477 COMPLIANCE. Subdivision 1. Medicare-certified providers; coordination of surveys. If feasible, the commissioner shall survey licensees to determine compliance with this chapter at the same time as surveys for certification for Medicare if Medicare certification is based on compliance with the federal conditions of participation and on survey and enforcement by the Department of Health as agent for the United States Department of Health and Human Services. Subd. 2. Medicare-certified providers; equivalent requirements. For home care providers licensed to provide comprehensive home care services that are also certified for participation in Medicare as a home health agency under Code of Federal Regulations, title 42, part 484, the following state licensure regulations are considered equivalent to the federal requirements: (1) quality management, section 144A.479, subdivision 3; (2) personnel records, section 144A.479, subdivision 7; (3) acceptance of clients, section 144A.4791, subdivision 4; (4) referrals, section 144A.4791, subdivision 5; (5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792, subdivisions 2 and 3;
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(6) individualized monitoring and reassessment, sections 144A.4791, subdivision 8, and 144A.4792, subdivisions 2 and 3; (7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792, subdivision 5, and 144A.4793, subdivision 3; (8) client complaint and investigation process, section 144A.4791, subdivision 11; (9) prescription orders, section 144A.4792, subdivisions 13 to 16; (10) client records, section 144A.4794, subdivisions 1 to 3; (11) qualifications for unlicensed personnel performing delegated tasks, section 144A.4795; (12) training and competency staff, section 144A.4795; (13) training and competency for unlicensed personnel, section 144A.4795, subdivision 7; (14) delegation of home care services, section 144A.4795, subdivision 4; (15) availability of contact person, section 144A.4797, subdivision 1; and (16) supervision of staff, section 144A.4797, subdivisions 2 and 3. Violations of requirements in clauses (1) to (16) may lead to enforcement actions under section 144A.474. History: 2013 c 108 art 11 s 16; 2014 c 275 art 1 s 135 144A.478 INNOVATION VARIANCE. Subdivision 1. Definition. For purposes of this section, "innovation variance" means a specified alternative to a requirement of this chapter. An innovation variance may be granted to allow a home care provider to offer home care services of a type or in a manner that is innovative, will not impair the services provided, will not adversely affect the health, safety, or welfare of the clients, and is likely to improve the services provided. The innovative variance cannot change any of the client's rights under section 144A.44, home care bill of rights. Subd. 2. Conditions. The commissioner may impose conditions on the granting of an innovation variance that the commissioner considers necessary. Subd. 3. Duration and renewal. The commissioner may limit the duration of any innovation variance and may renew a limited innovation variance. Subd. 4. Applications; innovation variance. An application for innovation variance from the requirements of this chapter may be made at any time, must be made in writing to the commissioner, and must specify the following: (1) the statute or law from which the innovation variance is requested; (2) the time period for which the innovation variance is requested; (3) the specific alternative action that the licensee proposes; (4) the reasons for the request; and
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(5) justification that an innovation variance will not impair the services provided, will not adversely affect the health, safety, or welfare of clients, and is likely to improve the services provided. The commissioner may require additional information from the home care provider before acting on the request. Subd. 5. Grants and denials. The commissioner shall grant or deny each request for an innovation variance in writing within 45 days of receipt of a complete request. Notice of a denial shall contain the reasons for the denial. The terms of a requested innovation variance may be modified upon agreement between the commissioner and the home care provider. Subd. 6. Violation of innovation variances. A failure to comply with the terms of an innovation variance shall be deemed to be a violation of this chapter. Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or deny renewal of an innovation variance if: (1) it is determined that the innovation variance is adversely affecting the health, safety, or welfare of the licensee's clients; (2) the home care provider has failed to comply with the terms of the innovation variance; (3) the home care provider notifies the commissioner in writing that it wishes to relinquish the innovation variance and be subject to the statute previously varied; or (4) the revocation or denial is required by a change in law. History: 2013 c 108 art 11 s 17; 2014 c 275 art 1 s 135 144A.479 HOME CARE PROVIDER RESPONSIBILITIES; BUSINESS OPERATION. Subdivision 1. Display of license. The original current license must be displayed in the home care provider's principal business office and copies must be displayed in any branch office. The home care provider must provide a copy of the license to any person who requests it. Subd. 2. Advertising. Home care providers shall not use false, fraudulent, or misleading advertising in the marketing of services. For purposes of this section, advertising includes any verbal, written, or electronic means of communicating to potential clients about the availability, nature, or terms of home care services. Subd. 3. Quality management. The home care provider shall engage in quality management appropriate to the size of the home care provider and relevant to the type of services the home care provider provides. The quality management activity means evaluating the quality of care by periodically reviewing client services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to clients. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal. Subd. 4. Provider restrictions. (a) This subdivision does not apply to licensees that are Minnesota counties or other units of government. (b) A home care provider or staff cannot accept powers-of-attorney from clients for any purpose, and may not accept appointments as guardians or conservators of clients. (c) A home care provider cannot serve as a client's representative.
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Subd. 5. Handling of client's finances and property. (a) A home care provider may assist clients with household budgeting, including paying bills and purchasing household goods, but may not otherwise manage a client's property. A home care provider must provide a client with receipts for all transactions and purchases paid with the client's funds. When receipts are not available, the transaction or purchase must be documented. A home care provider must maintain records of all such transactions. (b) A home care provider or staff may not borrow a client's funds or personal or real property, nor in any way convert a client's property to the home care provider's or staff's possession. (c) Nothing in this section precludes a home care provider or staff from accepting gifts of minimal value, or precludes the acceptance of donations or bequests made to a home care provider that are exempt from income tax under section 501(c) of the Internal Revenue Code of 1986. Subd. 6. Reporting maltreatment of vulnerable adults and minors. (a) All home care providers must comply with requirements for the reporting of maltreatment of minors in section 626.556 and the requirements for the reporting of maltreatment of vulnerable adults in section 626.557. Each home care provider must establish and implement a written procedure to ensure that all cases of suspected maltreatment are reported. (b) Each home care provider must develop and implement an individual abuse prevention plan for each vulnerable minor or adult for whom home care services are provided by a home care provider. The plan shall contain an individualized review or assessment of the person's susceptibility to abuse by another individual, including other vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors; and statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults or minors. For purposes of the abuse prevention plan, the term abuse includes self-abuse. Subd. 7. Employee records. The home care provider must maintain current records of each paid employee, regularly scheduled volunteers providing home care services, and of each individual contractor providing home care services. The records must include the following information: (1) evidence of current professional licensure, registration, or certification, if licensure, registration, or certification is required by this statute or other rules; (2) records of orientation, required annual training and infection control training, and competency evaluations; (3) current job description, including qualifications, responsibilities, and identification of staff providing supervision; (4) documentation of annual performance reviews which identify areas of improvement needed and training needs; (5) for individuals providing home care services, verification that any health screenings required by infection control programs established under section 144A.4798 have taken place and the dates of those screenings; and (6) documentation of the background study as required under section 144.057. Each employee record must be retained for at least three years after a paid employee, home care volunteer, or contractor ceases to be employed by or under contract with the home care provider. If a home care provider ceases operation, employee records must be maintained for three years.
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Subd. 8. Labor market reporting. A home care provider shall comply with the labor market reporting requirements described in section 256B.4912, subdivision 1a. History: 2013 c 108 art 11 s 18; 2014 c 275 art 1 s 135; 1Sp2019 c 9 art 11 s 49,50 144A.4791 HOME CARE PROVIDER RESPONSIBILITIES WITH RESPECT TO CLIENTS. Subdivision 1. Home care bill of rights; notification to client. (a) The home care provider shall provide the client or the client's representative a written notice of the rights under section 144A.44 before the date that services are first provided to that client. The provider shall make all reasonable efforts to provide notice of the rights to the client or the client's representative in a language the client or client's representative can understand. (b) In addition to the text of the home care bill of rights in section 144A.44, subdivision 1, the notice shall also contain the following statement describing how to file a complaint with these offices. "If you have a complaint about the provider or the person providing your home care services, you may call, write, or visit the Office of Health Facility Complaints, Minnesota Department of Health. You may also contact the Office of Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health and Developmental Disabilities." The statement should include the telephone number, website address, e-mail address, mailing address, and street address of the Office of Health Facility Complaints at the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care, and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The statement should also include the home care provider's name, address, e-mail, telephone number, and name or title of the person at the provider to whom problems or complaints may be directed. It must also include a statement that the home care provider will not retaliate because of a complaint. (c) The home care provider shall obtain written acknowledgment of the client's receipt of the home care bill of rights or shall document why an acknowledgment cannot be obtained. The acknowledgment may be obtained from the client or the client's representative. Acknowledgment of receipt shall be retained in the client's record. Subd. 2. Notice of services for dementia, Alzheimer's disease, or related disorders. The home care provider that provides services to clients with dementia shall provide in written or electronic form, to clients and families or other persons who request it, a description of the training program and related training it provides, including the categories of employees trained, the frequency of training, and the basic topics covered. This information satisfies the disclosure requirements in section 325F.72, subdivision 2, clause (4). Subd. 3. Statement of home care services. Prior to the date that services are first provided to the client, a home care provider must provide to the client or the client's representative a written statement which identifies if the provider has a basic or comprehensive home care license, the services the provider is authorized to provide, and which services the provider cannot provide under the scope of the provider's license. The home care provider shall obtain written acknowledgment from the clients that the provider has provided the statement or must document why the provider could not obtain the acknowledgment. Subd. 4. Acceptance of clients. No home care provider may accept a person as a client unless the home care provider has staff, sufficient in qualifications, competency, and numbers, to adequately provide the services agreed to in the service plan and that are within the provider's scope of practice.
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Subd. 5. Referrals. If a home care provider reasonably believes that a client is in need of another medical or health service, including a licensed health professional, or social service provider, the home care provider shall: (1) determine the client's preferences with respect to obtaining the service; and (2) inform the client of resources available, if known, to assist the client in obtaining services. Subd. 6. Initiation of services. When a provider provides home care services to a client before the individualized review or assessment by a licensed health professional or registered nurse as required in subdivisions 7 and 8 is completed, the licensed health professional or registered nurse must complete a temporary plan with the client and orient staff assigned to deliver services as identified in the temporary plan. Subd. 7. Basic individualized client review and monitoring. (a) When services being provided are basic home care services, an individualized initial review of the client's needs and preferences must be conducted at the client's residence with the client or client's representative. This initial review must be completed within 30 days after the date that home care services are first provided. (b) Client monitoring and review must be conducted as needed based on changes in the needs of the client and cannot exceed 90 days from the date of the last review. The monitoring and review may be conducted at the client's residence or through the utilization of telecommunication methods based on practice standards that meet the individual client's needs. Subd. 8. Comprehensive assessment, monitoring, and reassessment. (a) When the services being provided are comprehensive home care services, an individualized initial assessment must be conducted in person by a registered nurse. When the services are provided by other licensed health professionals, the assessment must be conducted by the appropriate health professional. This initial assessment must be completed within five days after the date that home care services are first provided. (b) Client monitoring and reassessment must be conducted in the client's home no more than 14 days after the date that home care services are first provided. (c) Ongoing client monitoring and reassessment must be conducted as needed based on changes in the needs of the client and cannot exceed 90 days from the last date of the assessment. The monitoring and reassessment may be conducted at the client's residence or through the utilization of telecommunication methods based on practice standards that meet the individual client's needs. Subd. 9. Service plan, implementation, and revisions to service plan. (a) No later than 14 days after the date that home care services are first provided, a home care provider shall finalize a current written service plan. (b) The service plan and any revisions must include a signature or other authentication by the home care provider and by the client or the client's representative documenting agreement on the services to be provided. The service plan must be revised, if needed, based on client review or reassessment under subdivisions 7 and 8. The provider must provide information to the client about changes to the provider's fee for services and how to contact the Office of the Ombudsman for Long-Term Care. (c) The home care provider must implement and provide all services required by the current service plan.
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(d) The service plan and revised service plan must be entered into the client's record, including notice of a change in a client's fees when applicable. (e) Staff providing home care services must be informed of the current written service plan. (f) The service plan must include: (1) a description of the home care services to be provided, the fees for services, and the frequency of each service, according to the client's current review or assessment and client preferences; (2) the identification of the staff or categories of staff who will provide the services; (3) the schedule and methods of monitoring reviews or assessments of the client; (4) the schedule and methods of monitoring staff providing home care services; and (5) a contingency plan that includes: (i) the action to be taken by the home care provider and by the client or client's representative if the scheduled service cannot be provided; (ii) information and a method for a client or client's representative to contact the home care provider; (iii) names and contact information of persons the client wishes to have notified in an emergency or if there is a significant adverse change in the client's condition; and (iv) the circumstances in which emergency medical services are not to be summoned consistent with chapters 145B and 145C, and declarations made by the client under those chapters. Subd. 10. Termination of service plan. (a) If a home care provider terminates a service plan with a client, and the client continues to need home care services, the home care provider shall provide the client and the client's representative, if any, with a written notice of termination which includes the following information: (1) the effective date of termination; (2) the reason for termination; (3) a list of known licensed home care providers in the client's immediate geographic area; (4) a statement that the home care provider will participate in a coordinated transfer of care of the client to another home care provider, health care provider, or caregiver, as required by the home care bill of rights, section 144A.44, subdivision 1, clause (17); (5) the name and contact information of a person employed by the home care provider with whom the client may discuss the notice of termination; and (6) if applicable, a statement that the notice of termination of home care services does not constitute notice of termination of the housing with services contract with a housing with services establishment. (b) When the home care provider voluntarily discontinues services to all clients, the home care provider must notify the commissioner, lead agencies, and ombudsman for long-term care about its clients and comply with the requirements in this subdivision.
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Subd. 11. Client complaint and investigative process. (a) The home care provider must have a written policy and system for receiving, investigating, reporting, and attempting to resolve complaints from its clients or clients' representatives. The policy should clearly identify the process by which clients may file a complaint or concern about home care services and an explicit statement that the home care provider will not discriminate or retaliate against a client for expressing concerns or complaints. A home care provider must have a process in place to conduct investigations of complaints made by the client or the client's representative about the services in the client's plan that are or are not being provided or other items covered in the client's home care bill of rights. This complaint system must provide reasonable accommodations for any special needs of the client or client's representative if requested. (b) The home care provider must document the complaint, name of the client, investigation, and resolution of each complaint filed. The home care provider must maintain a record of all activities regarding complaints received, including the date the complaint was received, and the home care provider's investigation and resolution of the complaint. This complaint record must be kept for each event for at least two years after the date of entry and must be available to the commissioner for review. (c) The required complaint system must provide for written notice to each client or client's representative that includes: (1) the client's right to complain to the home care provider about the services received; (2) the name or title of the person or persons with the home care provider to contact with complaints; (3) the method of submitting a complaint to the home care provider; and (4) a statement that the provider is prohibited against retaliation according to paragraph (d). (d) A home care provider must not take any action that negatively affects a client in retaliation for a complaint made or a concern expressed by the client or the client's representative. Subd. 12. Disaster planning and emergency preparedness plan. The home care provider must have a written plan of action to facilitate the management of the client's care and services in response to a natural disaster, such as flood and storms, or other emergencies that may disrupt the home care provider's ability to provide care or services. The licensee must provide adequate orientation and training of staff on emergency preparedness. Subd. 13. Request for discontinuation of life-sustaining treatment. (a) If a client, family member, or other caregiver of the client requests that an employee or other agent of the home care provider discontinue a life-sustaining treatment, the employee or agent receiving the request: (1) shall take no action to discontinue the treatment; and (2) shall promptly inform the supervisor or other agent of the home care provider of the client's request. (b) Upon being informed of a request for termination of treatment, the home care provider shall promptly: (1) inform the client that the request will be made known to the physician or advanced practice registered nurse who ordered the client's treatment; (2) inform the physician or advanced practice registered nurse of the client's request; and (3) work with the client and the client's physician or advanced practice registered nurse to comply with the provisions of the Health Care Directive Act in chapter 145C.
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(c) This section does not require the home care provider to discontinue treatment, except as may be required by law or court order. (d) This section does not diminish the rights of clients to control their treatments, refuse services, or terminate their relationships with the home care provider. (e) This section shall be construed in a manner consistent with chapter 145B or 145C, whichever applies, and declarations made by clients under those chapters. Subd. 14. Application of other law. Home care providers may exercise the authority and are subject to the protections in section 152.34. History: 2013 c 108 art 11 s 19; 2014 c 275 art 1 s 135; 2016 c 179 s 11; 2018 c 170 s 3; 1Sp2019 c 9 art 11 s 51-56 144A.4792 MEDICATION MANAGEMENT. Subdivision 1. Medication management services; comprehensive home care license. (a) This subdivision applies only to home care providers with a comprehensive home care license that provide medication management services to clients. Medication management services may not be provided by a home care provider who has a basic home care license. (b) A comprehensive home care provider who provides medication management services must develop, implement, and maintain current written medication management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current practice standards and guidelines. (c) The written policies and procedures must address requesting and receiving prescriptions for medications; preparing and giving medications; verifying that prescription drugs are administered as prescribed; documenting medication management activities; controlling and storing medications; monitoring and evaluating medication use; resolving medication errors; communicating with the prescriber, pharmacist, and client and client representative, if any; disposing of unused medications; and educating clients and client representatives about medications. When controlled substances are being managed, stored, and secured by the comprehensive home care provider, the policies and procedures must also identify how the provider will ensure security and accountability for the overall management, control, and disposition of those substances in compliance with state and federal regulations and with subdivision 22. Subd. 2. Provision of medication management services. (a) For each client who requests medication management services, the comprehensive home care provider shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber under section 151.37 conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must be conducted face-to-face with the client. The assessment must include an identification and review of all medications the client is known to be taking. The review and identification must include indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues. (b) The assessment must: (1) identify interventions needed in management of medications to prevent diversion of medication by the client or others who may have access to the medications; and
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(2) provide instructions to the client or client's representative on interventions to manage the client's medications and prevent diversion of medications. "Diversion of medications" means the misuse, theft, or illegal or improper disposition of medications. Subd. 3. Individualized medication monitoring and reassessment. The comprehensive home care provider must monitor and reassess the client's medication management services as needed under subdivision 2 when the client presents with symptoms or other issues that may be medication-related and, at a minimum, annually. Subd. 4. Client refusal. The home care provider must document in the client's record any refusal for an assessment for medication management by the client. The provider must discuss with the client the possible consequences of the client's refusal and document the discussion in the client's record. Subd. 5. Individualized medication management plan. (a) For each client receiving medication management services, the comprehensive home care provider must prepare and include in the service plan a written statement of the medication management services that will be provided to the client. The provider must develop and maintain a current individualized medication management record for each client based on the client's assessment that must contain the following: (1) a statement describing the medication management services that will be provided; (2) a description of storage of medications based on the client's needs and preferences, risk of diversion, and consistent with the manufacturer's directions; (3) documentation of specific client instructions relating to the administration of medications; (4) identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis; (5) identification of medication management tasks that may be delegated to unlicensed personnel; (6) procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; and (7) any client-specific requirements relating to documenting medication administration, verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions. (b) The medication management record must be current and updated when there are any changes. (c) Medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management. Subd. 6. Administration of medication. Medications may be administered by a nurse, physician, or other licensed health practitioner authorized to administer medications or by unlicensed personnel who have been delegated medication administration tasks by a registered nurse. Subd. 7. Delegation of medication administration. When administration of medications is delegated to unlicensed personnel, the comprehensive home care provider must ensure that the registered nurse has: (1) instructed the unlicensed personnel in the proper methods to administer the medications, and the unlicensed personnel has demonstrated the ability to competently follow the procedures;
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(2) specified, in writing, specific instructions for each client and documented those instructions in the client's records; and (3) communicated with the unlicensed personnel about the individual needs of the client. Subd. 8. Documentation of administration of medications. Each medication administered by comprehensive home care provider staff must be documented in the client's record. The documentation must include the signature and title of the person who administered the medication. The documentation must include the medication name, dosage, date and time administered, and method and route of administration. The staff must document the reason why medication administration was not completed as prescribed and document any follow-up procedures that were provided to meet the client's needs when medication was not administered as prescribed and in compliance with the client's medication management plan. Subd. 9. Documentation of medication setup. Documentation of dates of medication setup, name of medication, quantity of dose, times to be administered, route of administration, and name of person completing medication setup must be done at the time of setup. Subd. 10. Medication management for clients who will be away from home. (a) A home care provider who is providing medication management services to the client and controls the client's access to the medications must develop and implement policies and procedures for giving accurate and current medications to clients for planned or unplanned times away from home according to the client's individualized medication management plan. The policy and procedures must state that: (1) for planned time away, the medications must be obtained from the pharmacy or set up by a licensed nurse according to appropriate state and federal laws and nursing standards of practice; (2) for unplanned time away, when the pharmacy is not able to provide the medications, a licensed nurse or unlicensed personnel shall give the client or client's representative medications in amounts and dosages needed for the length of the anticipated absence, not to exceed seven calendar days; (3) the client or client's representative must be provided written information on medications, including any special instructions for administering or handling the medications, including controlled substances; (4) the medications must be placed in a medication container or containers appropriate to the provider's medication system and must be labeled with the client's name and the dates and times that the medications are scheduled; and (5) the client or client's representative must be provided in writing the home care provider's name and information on how to contact the home care provider. (b) For unplanned time away when the licensed nurse is not available, the registered nurse may delegate this task to unlicensed personnel if: (1) the registered nurse has trained the unlicensed staff and determined the unlicensed staff is competent to follow the procedures for giving medications to clients; and (2) the registered nurse has developed written procedures for the unlicensed personnel, including any special instructions or procedures regarding controlled substances that are prescribed for the client. The procedures must address: (i) the type of container or containers to be used for the medications appropriate to the provider's medication system;
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(ii) how the container or containers must be labeled; (iii) the written information about the medications to be given to the client or client's representative; (iv) how the unlicensed staff must document in the client's record that medications have been given to the client or the client's representative, including documenting the date the medications were given to the client or the client's representative and who received the medications, the person who gave the medications to the client, the number of medications that were given to the client, and other required information; (v) how the registered nurse shall be notified that medications have been given to the client or client's representative and whether the registered nurse needs to be contacted before the medications are given to the client or the client's representative; (vi) a review by the registered nurse of the completion of this task to verify that this task was completed accurately by the unlicensed personnel; and (vii) how the unlicensed staff must document in the client's record any unused medications that are returned to the provider, including the name of each medication and the doses of each returned medication. Subd. 11. Prescribed and nonprescribed medication. The comprehensive home care provider must determine whether the comprehensive home care provider shall require a prescription for all medications the provider manages. The comprehensive home care provider must inform the client or the client's representative whether the comprehensive home care provider requires a prescription for all over-the-counter and dietary supplements before the comprehensive home care provider agrees to manage those medications. Subd. 12. Medications; over-the-counter; dietary supplements not prescribed. A comprehensive home care provider providing medication management services for over-the-counter drugs or dietary supplements must retain those items in the original labeled container with directions for use prior to setting up for immediate or later administration. The provider must verify that the medications are up-to-date and stored as appropriate. Subd. 13. Prescriptions. There must be a current written or electronically recorded prescription as defined in section 151.01, subdivision 16a, for all prescribed medications that the comprehensive home care provider is managing for the client. Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least every 12 months or more frequently as indicated by the assessment in subdivision 2. Prescriptions for controlled substances must comply with chapter 152. Subd. 15. Verbal prescription orders. Verbal prescription orders from an authorized prescriber must be received by a nurse or pharmacist. The order must be handled according to Minnesota Rules, part 6800.6200. Subd. 16. Written or electronic prescription. When a written or electronic prescription is received, it must be communicated to the registered nurse in charge and recorded or placed in the client's record. Subd. 17. Records confidential. A prescription or order received verbally, in writing, or electronically must be kept confidential according to sections 144.291 to 144.298 and 144A.44. Subd. 18. Medications provided by client or family members. When the comprehensive home care provider is aware of any medications or dietary supplements that are being used by the client and are not included in the assessment for medication management services, the staff must advise the registered nurse and document that in the client's record.
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Subd. 19. Storage of medications. A comprehensive home care provider providing storage of medications outside of the client's private living space must store all prescription medications in securely locked and substantially constructed compartments according to the manufacturer's directions and permit only authorized personnel to have access. Subd. 20. Prescription drugs. A prescription drug, prior to being set up for immediate or later administration, must be kept in the original container in which it was dispensed by the pharmacy bearing the original prescription label with legible information including the expiration or beyond-use date of a time-dated drug. Subd. 21. Prohibitions. No prescription drug supply for one client may be used or saved for use by anyone other than the client. Subd. 22. Disposition of medications. (a) Any current medications being managed by the comprehensive home care provider must be given to the client or the client's representative when the client's service plan ends or medication management services are no longer part of the service plan. Medications that have been stored in the client's private living space for a client who is deceased or that have been discontinued or that have expired may be given to the client or the client's representative for disposal. (b) The comprehensive home care provider will dispose of any medications remaining with the comprehensive home care provider that are discontinued or expired or upon the termination of the service contract or the client's death according to state and federal regulations for disposition of medications and controlled substances. (c) Upon disposition, the comprehensive home care provider must document in the client's record the disposition of the medication including the medication's name, strength, prescription number as applicable, quantity, to whom the medications were given, date of disposition, and names of staff and other individuals involved in the disposition. Subd. 23. Loss or spillage. (a) Comprehensive home care providers providing medication management must develop and implement procedures for loss or spillage of all controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must require that when a spillage of a controlled substance occurs, a notation must be made in the client's record explaining the spillage and the actions taken. The notation must be signed by the person responsible for the spillage and include verification that any contaminated substance was disposed of according to state or federal regulations. (b) The procedures must require the comprehensive home care provider of medication management to investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state or federal regulations and document the investigation in required records. History: 2013 c 108 art 11 s 20; 2014 c 275 art 1 s 26,135; 2016 c 179 s 12; 1Sp2019 c 9 art 11 s 57-60 144A.4793 TREATMENT AND THERAPY MANAGEMENT SERVICES. Subdivision 1. Providers with a comprehensive home care license. This section applies only to home care providers with a comprehensive home care license that provide treatment or therapy management services to clients. Treatment or therapy management services cannot be provided by a home care provider that has a basic home care license. Subd. 2. Policies and procedures. (a) A comprehensive home care provider who provides treatment and therapy management services must develop, implement, and maintain up-to-date written treatment or therapy management policies and procedures. The policies and procedures must be developed under the
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supervision and direction of a registered nurse or appropriate licensed health professional consistent with current practice standards and guidelines. (b) The written policies and procedures must address requesting and receiving orders or prescriptions for treatments or therapies, providing the treatment or therapy, documenting of treatment or therapy activities, educating and communicating with clients about treatments or therapy they are receiving, monitoring and evaluating the treatment and therapy, and communicating with the prescriber. Subd. 3. Individualized treatment or therapy management plan. For each client receiving management of ordered or prescribed treatments or therapy services, the comprehensive home care provider must prepare and include in the service plan a written statement of the treatment or therapy services that will be provided to the client. The provider must also develop and maintain a current individualized treatment and therapy management record for each client which must contain at least the following: (1) a statement of the type of services that will be provided; (2) documentation of specific client instructions relating to the treatments or therapy administration; (3) identification of treatment or therapy tasks that will be delegated to unlicensed personnel; (4) procedures for notifying a registered nurse or appropriate licensed health professional when a problem arises with treatments or therapy services; and (5) any client-specific requirements relating to documentation of treatment and therapy received, verification that all treatment and therapy was administered as prescribed, and monitoring of treatment or therapy to prevent possible complications or adverse reactions. The treatment or therapy management record must be current and updated when there are any changes. Subd. 4. Administration of treatments and therapy. Ordered or prescribed treatments or therapies must be administered by a nurse, physician, or other licensed health professional authorized to perform the treatment or therapy, or may be delegated or assigned to unlicensed personnel by the licensed health professional according to the appropriate practice standards for delegation or assignment. When administration of a treatment or therapy is delegated or assigned to unlicensed personnel, the home care provider must ensure that the registered nurse or authorized licensed health professional has: (1) instructed the unlicensed personnel in the proper methods with respect to each client and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each client and documented those instructions in the client's record; and (3) communicated with the unlicensed personnel about the individual needs of the client. Subd. 5. Documentation of administration of treatments and therapies. Each treatment or therapy administered by a comprehensive home care provider must be documented in the client's record. The documentation must include the signature and title of the person who administered the treatment or therapy and must include the date and time of administration. When treatment or therapies are not administered as ordered or prescribed, the provider must document the reason why it was not administered and any follow-up procedures that were provided to meet the client's needs. Subd. 6. Treatment and therapy orders. There must be an up-to-date written or electronically recorded order from an authorized prescriber for all treatments and therapies. The order must contain the name of the client, a description of the treatment or therapy to be provided, and the frequency, duration, and other
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information needed to administer the treatment or therapy. Treatment and therapy orders must be renewed at least every 12 months. History: 2013 c 108 art 11 s 21; 2014 c 275 art 1 s 135; 1Sp2019 c 9 art 11 s 61 144A.4794 CLIENT RECORD REQUIREMENTS. Subdivision 1. Client record. (a) The home care provider must maintain records for each client for whom it is providing services. Entries in the client records must be current, legible, permanently recorded, dated, and authenticated with the name and title of the person making the entry. (b) Client records, whether written or electronic, must be protected against loss, tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable relevant federal and state laws. The home care provider shall establish and implement written procedures to control use, storage, and security of client's records and establish criteria for release of client information. (c) The home care provider may not disclose to any other person any personal, financial, medical, or other information about the client, except: (1) as may be required by law; (2) to employees or contractors of the home care provider, another home care provider, other health care practitioner or provider, or inpatient facility needing information in order to provide services to the client, but only such information that is necessary for the provision of services; (3) to persons authorized in writing by the client or the client's representative to receive the information, including third-party payers; and (4) to representatives of the commissioner authorized to survey or investigate home care providers under this chapter or federal laws. Subd. 2. Access to records. The home care provider must ensure that the appropriate records are readily available to employees or contractors authorized to access the records. Client records must be maintained in a manner that allows for timely access, printing, or transmission of the records. Subd. 3. Contents of client record. Contents of a client record include the following for each client: (1) identifying information, including the client's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of an emergency contact, family members, client's representative, if any, or others as identified; (3) names, addresses, and telephone numbers of the client's health and medical service providers and other home care providers, if known; (4) health information, including medical history, allergies, and when the provider is managing medications, treatments or therapies that require documentation, and other relevant health records; (5) client's advance directives, if any; (6) the home care provider's current and previous assessments and service plans; (7) all records of communications pertinent to the client's home care services;
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(8) documentation of significant changes in the client's status and actions taken in response to the needs of the client including reporting to the appropriate supervisor or health care professional; (9) documentation of incidents involving the client and actions taken in response to the needs of the client including reporting to the appropriate supervisor or health care professional; (10) documentation that services have been provided as identified in the service plan; (11) documentation that the client has received and reviewed the home care bill of rights; (12) documentation that the client has been provided the statement of disclosure on limitations of services under section 144A.4791, subdivision 3; (13) documentation of complaints received and resolution; (14) discharge summary, including service termination notice and related documentation, when applicable; and (15) other documentation required under this chapter and relevant to the client's services or status. Subd. 4. Transfer of client records. If a client transfers to another home care provider or other health care practitioner or provider, or is admitted to an inpatient facility, the home care provider, upon request of the client or the client's representative, shall take steps to ensure a coordinated transfer including sending a copy or summary of the client's record to the new home care provider, the facility, or the client, as appropriate. Subd. 5. Record retention. Following the client's discharge or termination of services, a home care provider must retain a client's record for at least five years, or as otherwise required by state or federal regulations. Arrangements must be made for secure storage and retrieval of client records if the home care provider ceases business. History: 2013 c 108 art 11 s 22; 2014 c 275 art 1 s 135 144A.4795 HOME CARE PROVIDER RESPONSIBILITIES; STAFF. Subdivision 1. Qualifications, training, and competency. All staff providing home care services must: (1) be trained and competent in the provision of home care services consistent with current practice standards appropriate to the client's needs; and (2) be informed of the home care bill of rights under section 144A.44. Subd. 2. Licensed health professionals and nurses. (a) Licensed health professionals and nurses providing home care services as an employee of a licensed home care provider must possess a current Minnesota license or registration to practice. (b) Licensed health professionals and registered nurses must be competent in assessing client needs, planning appropriate home care services to meet client needs, implementing services, and supervising staff if assigned. (c) Nothing in this section limits or expands the rights of nurses or licensed health professionals to provide services within the scope of their licenses or registrations, as provided by law. Subd. 3. Unlicensed personnel. (a) Unlicensed personnel providing basic home care services must have: (1) successfully completed a training and competency evaluation appropriate to the services provided by the home care provider and the topics listed in subdivision 7, paragraph (b); or
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(2) demonstrated competency by satisfactorily completing a written or oral test on the tasks the unlicensed personnel will perform and in the topics listed in subdivision 7, paragraph (b); and successfully demonstrated competency of topics in subdivision 7, paragraph (b), clauses (5), (7), and (8), by a practical skills test. Unlicensed personnel providing home care services for a basic home care provider may not perform delegated nursing or therapy tasks. (b) Unlicensed personnel performing delegated nursing tasks for a comprehensive home care provider must: (1) have successfully completed training and demonstrated competency by successfully completing a written or oral test of the topics in subdivision 7, paragraphs (b) and (c), and a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5) and (7), and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; (2) satisfy the current requirements of Medicare for training or competency of home health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, section 483 or 484.36; or (3) have, before April 19, 1993, completed a training course for nursing assistants that was approved by the commissioner. (c) Unlicensed personnel performing therapy or treatment tasks delegated or assigned by a licensed health professional must meet the requirements for delegated tasks in subdivision 4 and any other training or competency requirements within the licensed health professional scope of practice relating to delegation or assignment of tasks to unlicensed personnel. Subd. 4. Delegation of home care tasks. A registered nurse or licensed health professional may delegate tasks only to staff who are competent and possess the knowledge and skills consistent with the complexity of the tasks and according to the appropriate Minnesota practice act. The comprehensive home care provider must establish and implement a system to communicate up-to-date information to the registered nurse or licensed health professional regarding the current available staff and their competency so the registered nurse or licensed health professional has sufficient information to determine the appropriateness of delegating tasks to meet individual client needs and preferences. Subd. 5. Individual contractors. When a home care provider contracts with an individual contractor excluded from licensure under section 144A.471 to provide home care services, the contractor must meet the same requirements required by this section for personnel employed by the home care provider. Subd. 6. Temporary staff. When a home care provider contracts with a temporary staffing agency excluded from licensure under section 144A.471, those individuals must meet the same requirements required by this section for personnel employed by the home care provider and shall be treated as if they are staff of the home care provider. Subd. 7. Requirements for instructors, training content, and competency evaluations for unlicensed personnel. (a) Instructors and competency evaluators must meet the following requirements: (1) training and competency evaluations of unlicensed personnel providing basic home care services must be conducted by individuals with work experience and training in providing home care services listed in section 144A.471, subdivisions 6 and 7; and (2) training and competency evaluations of unlicensed personnel providing comprehensive home care services must be conducted by a registered nurse, or another instructor may provide training in conjunction
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with the registered nurse. If the home care provider is providing services by licensed health professionals only, then that specific training and competency evaluation may be conducted by the licensed health professionals as appropriate. (b) Training and competency evaluations for all unlicensed personnel must include the following: (1) documentation requirements for all services provided; (2) reports of changes in the client's condition to the supervisor designated by the home care provider; (3) basic infection control, including blood-borne pathogens; (4) maintenance of a clean and safe environment; (5) appropriate and safe techniques in personal hygiene and grooming, including: (i) hair care and bathing; (ii) care of teeth, gums, and oral prosthetic devices; (iii) care and use of hearing aids; and (iv) dressing and assisting with toileting; (6) training on the prevention of falls for providers working with the elderly or individuals at risk of falls; (7) standby assistance techniques and how to perform them; (8) medication, exercise, and treatment reminders; (9) basic nutrition, meal preparation, food safety, and assistance with eating; (10) preparation of modified diets as ordered by a licensed health professional; (11) communication skills that include preserving the dignity of the client and showing respect for the client and the client's preferences, cultural background, and family; (12) awareness of confidentiality and privacy; (13) understanding appropriate boundaries between staff and clients and the client's family; (14) procedures to utilize in handling various emergency situations; and (15) awareness of commonly used health technology equipment and assistive devices. (c) In addition to paragraph (b), training and competency evaluation for unlicensed personnel providing comprehensive home care services must include: (1) observation, reporting, and documenting of client status; (2) basic knowledge of body functioning and changes in body functioning, injuries, or other observed changes that must be reported to appropriate personnel; (3) reading and recording temperature, pulse, and respirations of the client; (4) recognizing physical, emotional, cognitive, and developmental needs of the client;
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(5) safe transfer techniques and ambulation; (6) range of motioning and positioning; and (7) administering medications or treatments as required. (d) When the registered nurse or licensed health professional delegates tasks, they must ensure that prior to the delegation the unlicensed personnel is trained in the proper methods to perform the tasks or procedures for each client and are able to demonstrate the ability to competently follow the procedures and perform the tasks. If an unlicensed personnel has not regularly performed the delegated home care task for a period of 24 consecutive months, the unlicensed personnel must demonstrate competency in the task to the registered nurse or appropriate licensed health professional. The registered nurse or licensed health professional must document instructions for the delegated tasks in the client's record. History: 2013 c 108 art 11 s 23; 2014 c 275 art 1 s 135 144A.4796 ORIENTATION AND ANNUAL TRAINING REQUIREMENTS. Subdivision 1. Orientation of staff and supervisors to home care. All staff providing and supervising direct home care services must complete an orientation to home care licensing requirements and regulations before providing home care services to clients. The orientation may be incorporated into the training required under subdivision 6. The orientation need only be completed once for each staff person and is not transferable to another home care provider. Subd. 2. Content. (a) The orientation must contain the following topics: (1) an overview of sections 144A.43 to 144A.4798; (2) introduction and review of all the provider's policies and procedures related to the provision of home care services by the individual staff person; (3) handling of emergencies and use of emergency services; (4) compliance with and reporting of the maltreatment of minors or vulnerable adults under sections 626.556 and 626.557; (5) home care bill of rights under section 144A.44; (6) handling of clients' complaints, reporting of complaints, and where to report complaints including information on the Office of Health Facility Complaints and the Common Entry Point; (7) consumer advocacy services of the Office of Ombudsman for Long-Term Care, Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care Ombudsman at the Department of Human Services, county managed care advocates, or other relevant advocacy services; and (8) review of the types of home care services the employee will be providing and the provider's scope of licensure. (b) In addition to the topics listed in paragraph (a), orientation may also contain training on providing services to clients with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research-based, may include online training, and must include training on one or more of the following topics:
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(1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and challenges it poses to communication; (2) health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 3. Verification and documentation of orientation. Each home care provider shall retain evidence in the employee record of each staff person having completed the orientation required by this section. Subd. 4. Orientation to client. Staff providing home care services must be oriented specifically to each individual client and the services to be provided. This orientation may be provided in person, orally, in writing, or electronically. Subd. 5. Training required relating to Alzheimer's disease and related disorders. For home care providers that provide services for persons with Alzheimer's or related disorders, all direct care staff and supervisors working with those clients must receive training that includes a current explanation of Alzheimer's disease and related disorders, effective approaches to use to problem-solve when working with a client's challenging behaviors, and how to communicate with clients who have Alzheimer's or related disorders. Subd. 6. Required annual training. (a) All staff that perform direct home care services must complete at least eight hours of annual training for each 12 months of employment. The training may be obtained from the home care provider or another source and must include topics relevant to the provision of home care services. The annual training must include: (1) training on reporting of maltreatment of minors under section 626.556 and maltreatment of vulnerable adults under section 626.557, whichever is applicable to the services provided; (2) review of the home care bill of rights in section 144A.44; (3) review of infection control techniques used in the home and implementation of infection control standards including a review of hand-washing techniques; the need for and use of protective gloves, gowns, and masks; appropriate disposal of contaminated materials and equipment, such as dressings, needles, syringes, and razor blades; disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of communicable diseases; and (4) review of the provider's policies and procedures relating to the provision of home care services and how to implement those policies and procedures. (b) In addition to the topics listed in paragraph (a), annual training may also contain training on providing services to clients with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research-based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and challenges it poses to communication; (2) health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or
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144A.4797
(3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 7. Documentation. A home care provider must retain documentation in the employee records of the staff who have satisfied the orientation and training requirements of this section. History: 2013 c 108 art 11 s 24; 2014 c 275 art 1 s 135; 2017 c 51 s 1,2; 1Sp2019 c 9 art 11 s 62 144A.4797 PROVISION OF SERVICES. Subdivision 1. Availability of contact person to staff. (a) A home care provider with a basic home care license must have a person available to staff for consultation on items relating to the provision of services or about the client. (b) A home care provider with a comprehensive home care license must have a registered nurse available for consultation to staff performing delegated nursing tasks and must have an appropriate licensed health professional available if performing other delegated services such as therapies. (c) The appropriate contact person must be readily available either in person, by telephone, or by other means to the staff at times when the staff is providing services. Subd. 2. Supervision of staff; basic home care services. (a) Staff who perform basic home care services must be supervised periodically where the services are being provided to verify that the work is being performed competently and to identify problems and solutions to address issues relating to the staff's ability to provide the services. The supervision of the unlicensed personnel must be done by staff of the home care provider having the authority, skills, and ability to provide the supervision of unlicensed personnel and who can implement changes as needed, and train staff. (b) Supervision includes direct observation of unlicensed personnel while the unlicensed personnel are providing the services and may also include indirect methods of gaining input such as gathering feedback from the client. Supervisory review of staff must be provided at a frequency based on the staff person's competency and performance. (c) For an individual who is licensed as a home care provider, this section does not apply. Subd. 3. Supervision of staff providing delegated nursing or therapy home care tasks. (a) Staff who perform delegated nursing or therapy home care tasks must be supervised by an appropriate licensed health professional or a registered nurse periodically where the services are being provided to verify that the work is being performed competently and to identify problems and solutions related to the staff person's ability to perform the tasks. Supervision of staff performing medication or treatment administration shall be provided by a registered nurse or appropriate licensed health professional and must include observation of the staff administering the medication or treatment and the interaction with the client. (b) The direct supervision of staff performing delegated tasks must be provided within 30 days after the date on which the individual begins working for the home care provider and first performs delegated tasks for clients and thereafter as needed based on performance. This requirement also applies to staff who have not performed delegated tasks for one year or longer. Subd. 4. Documentation. A home care provider must retain documentation of supervision activities in the personnel records.
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Subd. 5. Exemption. This section does not apply to an individual licensed under sections 144A.43 to 144A.4798. History: 2013 c 108 art 11 s 25; 2014 c 275 art 1 s 135; 1Sp2019 c 9 art 11 s 63 144A.4798 DISEASE PREVENTION AND INFECTION CONTROL. Subdivision 1. Tuberculosis (TB) infection control. (a) A home care provider must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in the CDC's Morbidity and Mortality Weekly Report. This program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors, students, and volunteers. The commissioner shall provide technical assistance regarding implementation of the guidelines. (b) The home care provider must maintain written evidence of compliance with this subdivision. Subd. 2. Communicable diseases. A home care provider must follow current state requirements for prevention, control, and reporting of communicable diseases as defined in Minnesota Rules, parts 4605.7040, 4605.7044, 4605.7050, 4605.7075, 4605.7080, and 4605.7090. Subd. 3. Infection control program. A home care provider must establish and maintain an effective infection control program that complies with accepted health care, medical, and nursing standards for infection control. History: 2013 c 108 art 11 s 26; 1Sp2019 c 9 art 11 s 64 144A.4799 DEPARTMENT OF HEALTH LICENSED HOME CARE PROVIDER ADVISORY COUNCIL. Subdivision 1. Membership. The commissioner of health shall appoint eight persons to a home care and assisted living program advisory council consisting of the following: (1) three public members as defined in section 214.02 who shall be persons who are currently receiving home care services, persons who have received home care services within five years of the application date, persons who have family members receiving home care services, or persons who have family members who have received home care services within five years of the application date; (2) three Minnesota home care licensees representing basic and comprehensive levels of licensure who may be a managerial official, an administrator, a supervising registered nurse, or an unlicensed personnel performing home care tasks; (3) one member representing the Minnesota Board of Nursing; (4) one member representing the Office of Ombudsman for Long-Term Care; and (5) beginning July 1, 2021, one member of a county health and human services or county adult protection office. Subd. 2. Organizations and meetings. The advisory council shall be organized and administered under section 15.059 with per diems and costs paid within the limits of available appropriations. Meetings will be held quarterly and hosted by the department. Subcommittees may be developed as necessary by the commissioner. Advisory council meetings are subject to the Open Meeting Law under chapter 13D.
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144A.482
Subd. 3. Duties. (a) At the commissioner's request, the advisory council shall provide advice regarding regulations of Department of Health licensed home care providers in this chapter, including advice on the following: (1) community standards for home care practices; (2) enforcement of licensing standards and whether certain disciplinary actions are appropriate; (3) ways of distributing information to licensees and consumers of home care and assisted living; (4) training standards; (5) identifying emerging issues and opportunities in home care and assisted living; (6) identifying the use of technology in home and telehealth capabilities; (7) allowable home care licensing modifications and exemptions, including a method for an integrated license with an existing license for rural licensed nursing homes to provide limited home care services in an adjacent independent living apartment building owned by the licensed nursing home; and (8) recommendations for studies using the data in section 62U.04, subdivision 4, including but not limited to studies concerning costs related to dementia and chronic disease among an elderly population over 60 and additional long-term care costs, as described in section 62U.10, subdivision 6. (b) The advisory council shall perform other duties as directed by the commissioner. (c) The advisory council shall annually make recommendations to the commissioner for the purposes in section 144A.474, subdivision 11, paragraph (i). The recommendations shall address ways the commissioner may improve protection of the public under existing statutes and laws and include but are not limited to projects that create and administer training of licensees and their employees to improve residents' lives, supporting ways that licensees can improve and enhance quality care and ways to provide technical assistance to licensees to improve compliance; information technology and data projects that analyze and communicate information about trends of violations or lead to ways of improving client care; communications strategies to licensees and the public; and other projects or pilots that benefit clients, families, and the public. History: 2013 c 108 art 11 s 27; 2014 c 291 art 6 s 18; 2016 c 179 s 13,14; 1Sp2017 c 6 art 10 s 70; 2019 c 60 art 4 s 26; 1Sp2019 c 9 art 11 s 65,66 144A.48 MS 2002 [Repealed, 2002 c 252 s 25] 144A.481 MS 2018 [Repealed, 1Sp2019 c 9 art 11 s 112]
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144D.01
CHAPTER 144D HOUSING WITH SERVICES ESTABLISHMENT 144D.01
DEFINITIONS.
144D.06
OTHER LAWS.
144D.015
DEFINITION FOR PURPOSES OF LONG-TERM CARE INSURANCE.
144D.065
TRAINING IN DEMENTIA CARE REQUIRED.
144D.02
REGISTRATION REQUIRED.
144D.066
ENFORCEMENT OF DEMENTIA CARE TRAINING REQUIREMENTS.
144D.025
OPTIONAL REGISTRATION.
144D.07
RESTRAINTS.
144D.03
REGISTRATION.
144D.08
UNIFORM CONSUMER INFORMATION GUIDE.
144D.04
HOUSING WITH SERVICES CONTRACTS.
144D.045
INFORMATION CONCERNING ARRANGED HOME CARE PROVIDERS.
144D.09
TERMINATION OF LEASE.
144D.10
MANAGER REQUIREMENTS.
144D.05
AUTHORITY OF COMMISSIONER.
144D.11
EMERGENCY PLANNING.
144D.001 MS 2006 [Renumbered 15.001] 144D.01 DEFINITIONS. Subdivision 1. Scope. As used in sections 144D.01 to 144D.06, the following terms have the meanings given them. Subd. 2. Adult. "Adult" means a natural person who has attained the age of 18 years. Subd. 2a. Arranged home care provider. "Arranged home care provider" means a home care provider licensed under chapter 144A that provides services to some or all of the residents of a housing with services establishment and that is either the establishment itself or another entity with which the establishment has an arrangement. Subd. 3. Commissioner. "Commissioner" means the commissioner of health or the commissioner's designee. Subd. 3a. Direct-care staff. "Direct-care staff" means staff and employees who provide home care services listed in section 144A.471, subdivisions 6 and 7. Subd. 4. Housing with services establishment or establishment. (a) "Housing with services establishment" or "establishment" means: (1) an establishment providing sleeping accommodations to one or more adult residents, at least 80 percent of which are 55 years of age or older, and offering or providing, for a fee, one or more regularly scheduled health-related services or two or more regularly scheduled supportive services, whether offered or provided directly by the establishment or by another entity arranged for by the establishment; or (2) an establishment that registers under section 144D.025. (b) Housing with services establishment does not include: (1) a nursing home licensed under chapter 144A; (2) a hospital, certified boarding care home, or supervised living facility licensed under sections 144.50 to 144.56; (3) a board and lodging establishment licensed under chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, or under chapter 245D or 245G;
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(4) a board and lodging establishment which serves as a shelter for battered women or other similar purpose; (5) a family adult foster care home licensed by the Department of Human Services; (6) private homes in which the residents are related by kinship, law, or affinity with the providers of services; (7) residential settings for persons with developmental disabilities in which the services are licensed under chapter 245D; (8) a home-sharing arrangement such as when an elderly or disabled person or single-parent family makes lodging in a private residence available to another person in exchange for services or rent, or both; (9) a duly organized condominium, cooperative, common interest community, or owners' association of the foregoing where at least 80 percent of the units that comprise the condominium, cooperative, or common interest community are occupied by individuals who are the owners, members, or shareholders of the units; (10) services for persons with developmental disabilities that are provided under a license under chapter 245D; or (11) a temporary family health care dwelling as defined in sections 394.307 and 462.3593. Subd. 5. Supportive services. "Supportive services" means help with personal laundry, handling or assisting with personal funds of residents, or arranging for medical services, health-related services, social services, or transportation to medical or social services appointments. Arranging for services does not include making referrals, assisting a resident in contacting a service provider of the resident's choice, or contacting a service provider in an emergency. Subd. 6. Health-related services. "Health-related services" include professional nursing services, home health aide tasks, or the central storage of medication for residents. Subd. 7. Family adult foster care home. "Family adult foster care home" means an adult foster care home that is licensed by the Department of Human Services, that is the primary residence of the license holder, and in which the license holder is the primary caregiver. History: 1995 c 207 art 9 s 29; 1997 c 107 s 1; 1997 c 113 s 7-10; 3Sp1997 c 3 s 6; 1999 c 245 art 3 s 8; 2002 c 375 art 2 s 3; 2005 c 56 s 1; 2006 c 282 art 19 s 4; 2013 c 108 art 9 s 3; 2015 c 71 art 8 s 41; 2016 c 111 s 1; 2016 c 158 art 1 s 62; 2016 c 179 s 16; 2017 c 40 art 1 s 33; 2018 c 182 art 2 s 3; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.015 DEFINITION FOR PURPOSES OF LONG-TERM CARE INSURANCE. For purposes of consistency with terminology commonly used in long-term care insurance policies and notwithstanding chapter 144G, a housing with services establishment that is registered under section 144D.03 and that holds, or makes arrangements with an individual or entity that holds any type of home care license and all other licenses, permits, registrations, or other governmental approvals legally required for delivery
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144D.03
of the services the establishment offers or provides to its residents, constitutes an "assisted living facility" or "assisted living residence." History: 2004 c 185 s 1; 2006 c 282 art 19 s 5; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.02 REGISTRATION REQUIRED. No entity may establish, operate, conduct, or maintain a housing with services establishment in this state without registering and operating as required in sections 144D.01 to 144D.06. History: 1995 c 207 art 9 s 30; 2006 c 282 art 19 s 6; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.025 OPTIONAL REGISTRATION. An establishment that meets all the requirements of this chapter except that fewer than 80 percent of the adult residents are age 55 or older, or a supportive housing establishment developed and funded in whole or in part with funds provided specifically as part of the plan to end long-term homelessness required under Laws 2003, chapter 128, article 15, section 9, may, at its option, register as a housing with services establishment. History: 2002 c 375 art 2 s 4; 2005 c 159 art 5 s 2; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.03 REGISTRATION. Subdivision 1. Registration procedures. The commissioner shall establish forms and procedures for annual registration of housing with services establishments. The commissioner shall charge an annual registration fee of $155. No fee shall be refunded. A registered establishment shall notify the commissioner within 30 days of the date it is no longer required to be registered under this chapter or of any change in the business name or address of the establishment, the name or mailing address of the owner or owners, or the name or mailing address of the managing agent. There shall be no fee for submission of the notice. Subd. 1a. Surcharge for injunctive relief actions. The commissioner shall assess each housing with services establishment that offers or provides assisted living under chapter 144G a surcharge on the annual registration fee paid under subdivision 1, to pay for the commissioner's costs related to bringing actions for injunctive relief under section 144G.02, subdivision 2, paragraph (b), on or after July 1, 2007. The commissioner shall assess surcharges using a sliding scale under which the surcharge amount increases with the client capacity of an establishment. The commissioner shall adjust the surcharge as necessary to recover the projected costs of bringing actions for injunctive relief. The commissioner shall adjust the surcharge in accordance with section 16A.1285. Subd. 2. Registration information. The establishment shall provide the following information to the commissioner in order to be registered: (1) the business name, street address, and mailing address of the establishment;
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(2) the name and mailing address of the owner or owners of the establishment and, if the owner or owners are not natural persons, identification of the type of business entity of the owner or owners, and the names and addresses of the officers and members of the governing body, or comparable persons for partnerships, limited liability corporations, or other types of business organizations of the owner or owners; (3) the name and mailing address of the managing agent, whether through management agreement or lease agreement, of the establishment, if different from the owner or owners, and the name of the on-site manager, if any; (4) verification that the establishment has entered into a housing with services contract, as required in section 144D.04, with each resident or resident's representative; (5) verification that the establishment is complying with the requirements of section 325F.72, if applicable; (6) the name and address of at least one natural person who shall be responsible for dealing with the commissioner on all matters provided for in sections 144D.01 to 144D.06, and on whom personal service of all notices and orders shall be made, and who shall be authorized to accept service on behalf of the owner or owners and the managing agent, if any; (7) the signature of the authorized representative of the owner or owners or, if the owner or owners are not natural persons, signatures of at least two authorized representatives of each owner, one of which shall be an officer of the owner; and (8) whether services are included in the base rate to be paid by the resident. Personal service on the person identified under clause (6) by the owner or owners in the registration shall be considered service on the owner or owners, and it shall not be a defense to any action that personal service was not made on each individual or entity. The designation of one or more individuals under this subdivision shall not affect the legal responsibility of the owner or owners under sections 144D.01 to 144D.06. History: 1995 c 207 art 9 s 31; 1997 c 113 s 11; 1Sp2001 c 9 art 1 s 41; 2002 c 379 art 1 s 113; 2006 c 282 art 19 s 7,8; 2007 c 147 art 10 s 11; 1Sp2010 c 1 art 17 s 1; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.04 HOUSING WITH SERVICES CONTRACTS. Subdivision 1. Contract required. No housing with services establishment may operate in this state unless a written housing with services contract, as defined in subdivision 2, is executed between the establishment and each resident or resident's representative and unless the establishment operates in accordance with the terms of the contract. The resident or the resident's representative shall be given a complete copy of the contract and all supporting documents and attachments and any changes whenever changes are made. Subd. 2. Contents of contract. A housing with services contract, which need not be entitled as such to comply with this section, shall include at least the following elements in itself or through supporting documents or attachments: (1) the name, street address, and mailing address of the establishment; (2) the name and mailing address of the owner or owners of the establishment and, if the owner or owners is not a natural person, identification of the type of business entity of the owner or owners;
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144D.04
(3) the name and mailing address of the managing agent, through management agreement or lease agreement, of the establishment, if different from the owner or owners; (4) the name and address of at least one natural person who is authorized to accept service of process on behalf of the owner or owners and managing agent; (5) a statement describing the registration and licensure status of the establishment and any provider providing health-related or supportive services under an arrangement with the establishment; (6) the term of the contract; (7) a description of the services to be provided to the resident in the base rate to be paid by the resident, including a delineation of the portion of the base rate that constitutes rent and a delineation of charges for each service included in the base rate; (8) a description of any additional services, including home care services, available for an additional fee from the establishment directly or through arrangements with the establishment, and a schedule of fees charged for these services; (9) a conspicuous notice informing the tenant of the policy concerning the conditions under which and the process through which the contract may be modified, amended, or terminated, including whether a move to a different room or sharing a room would be required in the event that the tenant can no longer pay the current rent; (10) a description of the establishment's complaint resolution process available to residents including the toll-free complaint line for the Office of Ombudsman for Long-Term Care; (11) the resident's designated representative, if any; (12) the establishment's referral procedures if the contract is terminated; (13) requirements of residency used by the establishment to determine who may reside or continue to reside in the housing with services establishment; (14) billing and payment procedures and requirements; (15) a statement regarding the ability of a resident to receive services from service providers with whom the establishment does not have an arrangement; (16) a statement regarding the availability of public funds for payment for residence or services in the establishment; and (17) a statement regarding the availability of and contact information for long-term care consultation services under section 256B.0911 in the county in which the establishment is located. Subd. 2a. Additional contract requirements. (a) For a resident receiving one or more health-related services from the establishment's arranged home care provider, as defined in section 144D.01, subdivision 6, the contract must include the requirements in paragraph (b). A restriction of a resident's rights under this subdivision is allowed only if determined necessary for health and safety reasons identified by the home care provider's registered nurse in an initial assessment or reassessment, as defined under section 144A.4791, subdivision 8, and documented in the written service plan under section 144A.4791, subdivision 9. Any restrictions of those rights for people served under chapter 256S and section 256B.49 must be documented
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144D.04
MINNESOTA STATUTES 2019
in the resident's coordinated service and support plan (CSSP), as defined under sections 256B.49, subdivision 15, and 256S.10. (b) The contract must include a statement: (1) regarding the ability of a resident to furnish and decorate the resident's unit within the terms of the lease; (2) regarding the resident's right to access food at any time; (3) regarding a resident's right to choose the resident's visitors and times of visits; (4) regarding the resident's right to choose a roommate if sharing a unit; and (5) notifying the resident of the resident's right to have and use a lockable door to the resident's unit. The landlord shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible. Subd. 3. Contracts in permanent files. Housing with services contracts and related documents executed by each resident or resident's representative shall be maintained by the establishment in files from the date of execution until three years after the contract is terminated. The contracts and the written disclosures required under section 325F.72, if applicable, shall be made available for on-site inspection by the commissioner upon request at any time. History: 1995 c 207 art 9 s 32; 1Sp2001 c 9 art 1 s 42,43; 2002 c 379 art 1 s 113; 2006 c 282 art 19 s 9; 2007 c 147 art 7 s 75; 1Sp2010 c 1 art 17 s 2; 2012 c 247 art 4 s 4; 1Sp2017 c 6 art 2 s 1,2; art 10 s 73; 2019 c 54 art 2 s 3; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.045 INFORMATION CONCERNING ARRANGED HOME CARE PROVIDERS. If a housing with services establishment has one or more arranged home care providers, the establishment shall arrange to have that arranged home care provider deliver the following information in writing to a prospective resident, prior to the date on which the prospective resident executes a contract with the establishment or the prospective resident's move-in date, whichever is earlier: (1) the name, mailing address, and telephone number of the arranged home care provider; (2) the name and mailing address of at least one natural person who is authorized to accept service of process on behalf of the entity described in clause (1); (3) a description of the process through which a home care service agreement or service plan between a resident and the arranged home care provider, if any, may be modified, amended, or terminated; (4) the arranged home care provider's billing and payment procedures and requirements; and (5) any limits to the services available from the arranged provider. History: 2006 c 282 art 19 s 10; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.
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144D.065
144D.05 AUTHORITY OF COMMISSIONER. The commissioner shall, upon receipt of information which may indicate the failure of the housing with services establishment, a resident, a resident's representative, or a service provider to comply with a legal requirement to which one or more of them may be subject, make appropriate referrals to other governmental agencies and entities having jurisdiction over the subject matter. The commissioner may also make referrals to any public or private agency the commissioner considers available for appropriate assistance to those involved. The commissioner shall have standing to bring an action for injunctive relief in the district court in the district in which an establishment is located to compel the housing with services establishment to meet the requirements of this chapter or other requirements of the state or of any county or local governmental unit to which the establishment is otherwise subject. Proceedings for securing an injunction may be brought by the commissioner through the attorney general or through the appropriate county attorney. The sanctions in this section do not restrict the availability of other sanctions. History: 1995 c 207 art 9 s 33; 2006 c 282 art 19 s 11; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.06 OTHER LAWS. In addition to registration under this chapter, a housing with services establishment must comply with chapter 504B and the provisions of section 325F.72, and shall obtain and maintain all other licenses, permits, registrations, or other governmental approvals required of it. A housing with services establishment is not required to obtain a lodging license under chapter 157 and related rules. History: 1995 c 207 art 9 s 34; 1996 c 305 art 1 s 36; 1997 c 113 s 13; 1999 c 199 art 2 s 5; 1Sp2001 c 9 art 1 s 44; 2002 c 379 art 1 s 113; 1Sp2017 c 6 art 10 s 74; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.065 TRAINING IN DEMENTIA CARE REQUIRED. (a) If a housing with services establishment registered under this chapter has a special program or special care unit for residents with Alzheimer's disease or other dementias or advertises, markets, or otherwise promotes the establishment as providing services for persons with Alzheimer's disease or other dementias, whether in a segregated or general unit, employees of the establishment and of the establishment's arranged home care provider must meet the following training requirements: (1) supervisors of direct-care staff must have at least eight hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b), or a supervisor meeting the requirements in clause (1), must be available for consultation with the new employee until the training
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requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (3) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (4) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. (b) Areas of required training include: (1) an explanation of Alzheimer's disease and related disorders; (2) assistance with activities of daily living; (3) problem solving with challenging behaviors; and (4) communication skills. (c) The establishment shall provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered. This information satisfies the disclosure requirements of section 325F.72, subdivision 2, clause (4). (d) Housing with services establishments not included in paragraph (a) that provide assisted living services under chapter 144G must meet the following training requirements: (1) supervisors of direct-care staff must have at least four hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct-care employees must have completed at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial four hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or supervisor meeting the requirements under paragraph (a), clause (1), must be available for consultation with the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (3) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (4) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. History: 2003 c 37 s 3; 2006 c 282 art 19 s 12; 2014 c 291 art 6 s 19; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.
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MINNESOTA STATUTES 2019
144D.066
144D.066 ENFORCEMENT OF DEMENTIA CARE TRAINING REQUIREMENTS. Subdivision 1. Enforcement. (a) The commissioner shall enforce the dementia care training standards for staff working in housing with services settings and for housing managers according to clauses (1) to (3): (1) for dementia care training requirements in section 144D.065, the commissioner shall review training records as part of the home care provider survey process for direct care staff and supervisors of direct care staff, in accordance with section 144A.474. The commissioner may also request and review training records at any time during the year; (2) for dementia care training standards in section 144D.065, the commissioner shall review training records for maintenance, housekeeping, and food service staff and other staff not providing direct care working in housing with services settings as part of the housing with services registration application and renewal application process in accordance with section 144D.03. The commissioner may also request and review training records at any time during the year; and (3) for housing managers, the commissioner shall review the statement verifying compliance with the required training described in section 144D.10, paragraph (d), through the housing with services registration application and renewal application process in accordance with section 144D.03. The commissioner may also request and review training records at any time during the year. (b) The commissioner shall specify the required forms and what constitutes sufficient training records for the items listed in paragraph (a), clauses (1) to (3). Subd. 2. Fines for noncompliance. (a) Beginning January 1, 2017, the commissioner may impose a $200 fine for every staff person required to obtain dementia care training who does not have training records to show compliance. For violations of subdivision 1, paragraph (a), clause (1), the fine will be imposed upon the home care provider, and may be appealed under the contested case procedure in section 144A.475, subdivisions 3a, 4, and 7. For violations of subdivision 1, paragraph (a), clauses (2) and (3), the fine will be imposed on the housing with services registrant and may be appealed under the contested case procedure in section 144A.475, subdivisions 3a, 4, and 7. Prior to imposing the fine, the commissioner must allow two weeks for staff to complete the required training. Fines collected under this section shall be deposited in the state treasury and credited to the state government special revenue fund. (b) The housing with services registrant and home care provider must allow for the required training as part of employee and staff duties. Imposition of a fine by the commissioner does not negate the need for the required training. Continued noncompliance with the requirements of sections 144D.065 and 144D.10 may result in revocation or nonrenewal of the housing with services registration or home care license. The commissioner shall make public the list of all housing with services establishments that have complied with the training requirements. Subd. 3. Technical assistance. From January 1, 2016, to December 31, 2016, the commissioner shall provide technical assistance instead of imposing fines for noncompliance with the training requirements. During the year of technical assistance, the commissioner shall review the training records to determine if the records meet the requirements and inform the home care provider. The commissioner shall also provide information about available training resources. History: 2015 c 71 art 8 s 42; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.
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144D.07
MINNESOTA STATUTES 2019
144D.07 RESTRAINTS. Residents must be free from any physical or chemical restraints imposed for purposes of discipline or convenience. History: 1997 c 113 s 12; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.08 UNIFORM CONSUMER INFORMATION GUIDE. All housing with services establishments shall make available to all prospective and current residents information consistent with the uniform format and the required components adopted by the commissioner under section 144G.06. This section does not apply to an establishment registered under section 144D.025 serving the homeless. History: 1Sp2010 c 1 art 17 s 3; 2013 c 43 s 19; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.09 TERMINATION OF LEASE. The housing with services establishment shall include with notice of termination of lease information about how to contact the ombudsman for long-term care, including the address and telephone number along with a statement of how to request problem-solving assistance. History: 1Sp2010 c 1 art 17 s 4; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.10 MANAGER REQUIREMENTS. (a) The person primarily responsible for oversight and management of a housing with services establishment, as designated by the owner of the housing with services establishment, must obtain at least 30 hours of continuing education every two years of employment as the manager in topics relevant to the operations of the housing with services establishment and the needs of its tenants. Continuing education earned to maintain a professional license, such as nursing home administrator license, nursing license, social worker license, and real estate license, can be used to complete this requirement. (b) For managers of establishments identified in section 325F.72, this continuing education must include at least eight hours of documented training on the topics identified in section 144D.065, paragraph (b), within 160 working hours of hire, and two hours of training on these topics for each 12 months of employment thereafter. (c) For managers of establishments not covered by section 325F.72, but who provide assisted living services under chapter 144G, this continuing education must include at least four hours of documented training on the topics identified in section 144D.065, paragraph (b), within 160 working hours of hire, and two hours of training on these topics for each 12 months of employment thereafter. (d) A statement verifying compliance with the continuing education requirement must be included in the housing with services establishment's annual registration to the commissioner of health. The establishment
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144D.11
must maintain records for at least three years demonstrating that the person primarily responsible for oversight and management of the establishment has attended educational programs as required by this section. (e) New managers may satisfy the initial dementia training requirements by producing written proof of previously completed required training within the past 18 months. (f) This section does not apply to an establishment registered under section 144D.025 serving the homeless. History: 2014 c 291 art 6 s 20; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144D.11 EMERGENCY PLANNING. (a) Each registered housing with services establishment must meet the following requirements: (1) have a written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in-place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency; (2) post an emergency disaster plan prominently; (3) provide building emergency exit diagrams to all tenants upon signing a lease; (4) post emergency exit diagrams on each floor; and (5) have a written policy and procedure regarding missing tenants. (b) Each registered housing with services establishment must provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter and must make emergency and disaster training available to all tenants annually. Staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on site. (c) Each registered housing with services location must conduct and document a fire drill or other emergency drill at least every six months. To the extent possible, drills must be coordinated with local fire departments or other community emergency resources. History: 2014 c 291 art 6 s 21; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.
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MINNESOTA STATUTES 2019
CHAPTER 144G ASSISTED LIVING NOTE: Sections 144G.01 to 144G.06 are assisted living title protections that are repealed August 1, 2021. Section 144G.07 expires July 31, 2021. 144G.01
DEFINITIONS.
144G.51
ARBITRATION.
144G.02
ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION.
144G.52
ASSISTED LIVING CONTRACT TERMINATIONS.
144G.53
NONRENEWAL OF HOUSING.
144G.03
ASSISTED LIVING REQUIREMENTS.
144G.54
APPEALS OF CONTRACT TERMINATIONS.
144G.04
RESERVATION OF RIGHTS.
144G.55
COORDINATED MOVES.
144G.05
REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES.
144G.56
TRANSFER OF RESIDENTS WITHIN FACILITY.
144G.06
UNIFORM CONSUMER INFORMATION GUIDE.
144G.57
PLANNED CLOSURES.
144G.07
RETALIATION PROHIBITED. 144G.60
STAFFING REQUIREMENTS.
STAFFING REQUIREMENTS
ASSISTED LIVING LICENSURE 144G.08
DEFINITIONS.
144G.61
STAFF COMPETENCY EVALUATIONS.
144G.09
COMMISSIONER OVERSIGHT AND AUTHORITY OVER ASSISTED LIVING FACILITIES.
144G.62
DELEGATION AND SUPERVISION.
144G.63
ORIENTATION AND ANNUAL TRAINING REQUIREMENTS.
144G.64
TRAINING IN DEMENTIA CARE REQUIRED.
144G.70
SERVICES.
144G.71
MEDICATION MANAGEMENT.
144G.72
TREATMENT AND THERAPY MANAGEMENT SERVICES.
144G.10
ASSISTED LIVING FACILITY LICENSE.
144G.11
APPLICABILITY OF OTHER LAWS.
144G.12
APPLICATION FOR LICENSURE.
144G.13
BACKGROUND STUDIES OF LICENSE APPLICANTS.
144G.15
CONSIDERATION OF APPLICATIONS.
144G.16
PROVISIONAL LICENSE.
144G.17
LICENSE RENEWAL.
144G.18
NOTIFICATION OF CHANGES IN INFORMATION.
144G.19
TRANSFER OF LICENSE PROHIBITED.
SERVICES
ASSISTED LIVING FACILITIES WITH DEMENTIA CARE 144G.80
ADDITIONAL LICENSING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.
144G.81
ADDITIONAL REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH SECURED DEMENTIA CARE UNITS.
144G.82
ADDITIONAL RESPONSIBILITIES OF ADMINISTRATION FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.
144G.83
ADDITIONAL TRAINING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE.
144G.84
SERVICES FOR RESIDENTS WITH DEMENTIA.
ENFORCEMENT 144G.20
ENFORCEMENT.
SURVEYS, CORRECTION ORDERS, AND FINES 144G.30
SURVEYS AND INVESTIGATIONS.
144G.31
VIOLATIONS AND FINES.
144G.32
RECONSIDERATION OF CORRECTION ORDERS AND FINES.
144G.33
INNOVATION VARIANCE.
OPERATIONS AND PHYSICAL PLANT REQUIREMENTS 144G.40
HOUSING AND SERVICES.
144G.401
PAYMENT FOR SERVICES UNDER DISABILITY WAIVERS.
RESIDENT RIGHTS AND PROTECTIONS 144G.90
REQUIRED NOTICES.
144G.91
ASSISTED LIVING BILL OF RIGHTS.
144G.911
RESTRICTIONS UNDER HOME AND COMMUNITY-BASED WAIVERS.
144G.41
MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS.
144G.42
BUSINESS OPERATION.
144G.43
RESIDENT RECORD REQUIREMENTS.
144G.92
RETALIATION PROHIBITED.
MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS.
144G.93
CONSUMER ADVOCACY AND LEGAL SERVICES.
144G.95
OFFICE OF OMBUDSMAN FOR LONG-TERM CARE.
144G.9999
RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT TASK FORCE.
144G.45
CONTRACTS, TERMINATIONS, AND RELOCATIONS 144G.50
ASSISTED LIVING CONTRACT REQUIREMENTS.
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144G.01
MINNESOTA STATUTES 2019
144G.01 DEFINITIONS. Subdivision 1. Scope; other definitions. For purposes of sections 144G.01 to 144G.05, the following definitions apply. In addition, the definitions provided in section 144D.01 also apply to sections 144G.01 to 144G.05. Subd. 2. Assisted living. "Assisted living" means a service or package of services advertised, marketed, or otherwise described, offered, or promoted using the phrase "assisted living" either alone or in combination with other words, whether orally or in writing, and which is subject to the requirements of this chapter. Subd. 3. Assisted living client; client. "Assisted living client" or "client" means a housing with services resident who receives assisted living that is subject to the requirements of this chapter. Subd. 4. Commissioner. "Commissioner" means the commissioner of health. History: 2006 c 282 art 19 s 13; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.02 ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION. Subdivision 1. Protected title; restriction on use. No person or entity may use the phrase "assisted living," whether alone or in combination with other words and whether orally or in writing, to advertise, market, or otherwise describe, offer, or promote itself, or any housing, service, service package, or program that it provides within this state, unless the person or entity is a housing with services establishment that meets the requirements of this chapter, or is a person or entity that provides some or all components of assisted living that meet the requirements of this chapter. A person or entity entitled to use the phrase "assisted living" shall use the phrase only in the context of its participation in assisted living that meets the requirements of this chapter. A housing with services establishment offering or providing assisted living that is not made available to residents in all of its housing units shall identify the number or location of the units in which assisted living is available, and may not use the term "assisted living" in the name of the establishment registered with the commissioner under chapter 144D, or in the name the establishment uses to identify itself to residents or the public. Subd. 2. Authority of commissioner. (a) The commissioner, upon receipt of information that may indicate the failure of a housing with services establishment, the arranged home care provider, an assisted living client, or an assisted living client's representative to comply with a legal requirement to which one or more of the entities may be subject, shall make appropriate referrals to other governmental agencies and entities having jurisdiction over the subject matter. The commissioner may also make referrals to any public or private agency the commissioner considers available for appropriate assistance to those involved. (b) In addition to the authority with respect to licensed home care providers under section 144A.45 and with respect to housing with services establishments under chapter 144D, the commissioner shall have standing to bring an action for injunctive relief in the district court in the district in which a housing with services establishment is located to compel the housing with services establishment or the arranged home care provider to meet the requirements of this chapter or other requirements of the state or of any county or local governmental unit to which the establishment or arranged home care provider is otherwise subject. Proceedings for securing an injunction may be brought by the commissioner through the attorney general
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144G.03
or through the appropriate county attorney. The sanctions in this section do not restrict the availability of other sanctions. History: 2006 c 282 art 19 s 14; 2013 c 108 art 11 s 33; 2014 c 275 art 1 s 134,138; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.03 ASSISTED LIVING REQUIREMENTS. Subdivision 1. Verification in annual registration. A registered housing with services establishment using the phrase "assisted living," pursuant to section 144G.02, subdivision 1, shall verify to the commissioner in its annual registration pursuant to chapter 144D that the establishment is complying with sections 144G.01 to 144G.05, as applicable. Subd. 2. Minimum requirements for assisted living. (a) Assisted living shall be provided or made available only to individuals residing in a registered housing with services establishment. Except as expressly stated in this chapter, a person or entity offering assisted living may define the available services and may offer assisted living to all or some of the residents of a housing with services establishment. The services that comprise assisted living may be provided or made available directly by a housing with services establishment or by persons or entities with which the housing with services establishment has made arrangements. (b) A person or entity entitled to use the phrase "assisted living," according to section 144G.02, subdivision 1, shall do so only with respect to a housing with services establishment, or a service, service package, or program available within a housing with services establishment that, at a minimum: (1) provides or makes available health-related services under a home care license. At a minimum, health-related services must include: (i) assistance with self-administration of medication, medication management, or medication administration as defined in section 144A.43; and (ii) assistance with at least three of the following seven activities of daily living: bathing, dressing, grooming, eating, transferring, continence care, and toileting. All health-related services shall be provided in a manner that complies with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (2) provides necessary assessments of the physical and cognitive needs of assisted living clients by a registered nurse, as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (3) has and maintains a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285; (4) provides staff access to an on-call registered nurse 24 hours per day, seven days per week; (5) has and maintains a system to check on each assisted living client at least daily;
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144G.03
MINNESOTA STATUTES 2019
(6) provides a means for assisted living clients to request assistance for health and safety needs 24 hours per day, seven days per week, from the establishment or a person or entity with which the establishment has made arrangements; (7) has a person or persons available 24 hours per day, seven days per week, who is responsible for responding to the requests of assisted living clients for assistance with health or safety needs, who shall be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the housing with services establishment in order to respond within a reasonable amount of time; (iii) capable of communicating with assisted living clients; (iv) capable of recognizing the need for assistance; (v) capable of providing either the assistance required or summoning the appropriate assistance; and (vi) capable of following directions; (8) offers to provide or make available at least the following supportive services to assisted living clients: (i) two meals per day; (ii) weekly housekeeping; (iii) weekly laundry service; (iv) upon the request of the client, reasonable assistance with arranging for transportation to medical and social services appointments, and the name of or other identifying information about the person or persons responsible for providing this assistance; (v) upon the request of the client, reasonable assistance with accessing community resources and social services available in the community, and the name of or other identifying information about the person or persons responsible for providing this assistance; and (vi) periodic opportunities for socialization; and (9) makes available to all prospective and current assisted living clients information consistent with the uniform format and the required components adopted by the commissioner under section 144G.06. This information must be made available beginning no later than six months after the commissioner makes the uniform format and required components available to providers according to section 144G.06. Subd. 3. Exemption from awake-staff requirement. A housing with services establishment that offers or provides assisted living is exempt from the requirement in subdivision 2, paragraph (b), clause (7), item (i), that the person or persons available and responsible for responding to requests for assistance must be awake, if the establishment meets the following requirements: (1) the establishment has a maximum capacity to serve 12 or fewer assisted living clients; (2) the person or persons available and responsible for responding to requests for assistance are physically present within the housing with services establishment in which the assisted living clients reside; (3) the establishment has a system in place that is compatible with the health, safety, and welfare of the establishment's assisted living clients;
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144G.03
(4) the establishment's housing with services contract, as required by section 144D.04, includes a statement disclosing the establishment's qualification for, and intention to rely upon, this exemption; (5) the establishment files with the commissioner, for purposes of public information but not review or approval by the commissioner, a statement describing how the establishment meets the conditions in clauses (1) to (4), and makes a copy of this statement available to actual and prospective assisted living clients; and (6) the establishment indicates on its housing with services registration, under section 144D.02 or 144D.03, as applicable, that it qualifies for and intends to rely upon the exemption under this subdivision. Subd. 4. Nursing assessment. (a) A housing with services establishment offering or providing assisted living shall: (1) offer to have the arranged home care provider conduct a nursing assessment by a registered nurse of the physical and cognitive needs of the prospective resident and propose a service plan prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier; and (2) inform the prospective resident of the availability of and contact information for long-term care consultation services under section 256B.0911, prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier. (b) An arranged home care provider is not obligated to conduct a nursing assessment by a registered nurse when requested by a prospective resident if either the geographic distance between the prospective resident and the provider, or urgent or unexpected circumstances, do not permit the assessment to be conducted prior to the date on which the prospective resident executes a contract or moves in, whichever is earlier. When such circumstances occur, the arranged home care provider shall offer to conduct a telephone conference whenever reasonably possible. (c) The arranged home care provider shall comply with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285, with respect to the provision of a nursing assessment prior to the delivery of nursing services and the execution of a home care service plan or service agreement. Subd. 5. Assistance with arranged home care provider. The housing with services establishment shall provide each assisted living client with identifying information about a person or persons reasonably available to assist the client with concerns the client may have with respect to the services provided by the arranged home care provider. The establishment shall keep each assisted living client reasonably informed of any changes in the personnel referenced in this subdivision. Upon request of the assisted living client, such personnel or designee shall provide reasonable assistance to the assisted living client in addressing concerns regarding services provided by the arranged home care provider. Subd. 6. Termination of housing with services contract. If a housing with services establishment terminates a housing with services contract with an assisted living client, the establishment shall provide the assisted living client, and the legal or designated representative of the assisted living client, if any, with a written notice of termination which includes the following information: (1) the effective date of termination; (2) the section of the contract that authorizes the termination;
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(3) without extending the termination notice period, an affirmative offer to meet with the assisted living client and, if applicable, client representatives, within no more than five business days of the date of the termination notice to discuss the termination; (4) an explanation that: (i) the assisted living client must vacate the apartment, along with all personal possessions, on or before the effective date of termination; (ii) failure to vacate the apartment by the date of termination may result in the filing of an eviction action in court by the establishment, and that the assisted living client may present a defense, if any, to the court at that time; and (iii) the assisted living client may seek legal counsel in connection with the notice of termination; (5) a statement that, with respect to the notice of termination, reasonable accommodation is available for the disability of the assisted living client, if any; and (6) the name and contact information of the representative of the establishment with whom the assisted living client or client representatives may discuss the notice of termination. History: 2006 c 282 art 19 s 15; 2016 c 179 s 17,18; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.04 RESERVATION OF RIGHTS. Subdivision 1. Use of services. Nothing in this chapter requires an assisted living client to utilize any service provided or made available in assisted living. Subd. 2. Housing with services contracts. Nothing in this chapter requires a housing with services establishment to execute or refrain from terminating a housing with services contract with a prospective or current resident who is unable or unwilling to meet the requirements of residency, with or without assistance. Subd. 3. Provision of services. Nothing in this chapter requires the arranged home care provider to offer or continue to provide services under a service agreement or service plan to a prospective or current resident of the establishment whose needs cannot be met by the arranged home care provider. Subd. 4. Altering operations; service packages. Nothing in this chapter requires a housing with services establishment or arranged home care provider offering assisted living to fundamentally alter the nature of the operations of the establishment or the provider in order to accommodate the request or need for facilities or services by any assisted living client, or to refrain from requiring, as a condition of residency, that an assisted living client pay for a package of assisted living services even if the client does not choose to utilize all or some of the services in the package. History: 2006 c 282 art 19 s 16; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48.
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144G.05 REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES. Notwithstanding the provisions of this chapter, the requirements for the elderly waiver program's assisted living payment rates under sections 256S.201 and 256S.202 shall continue to be effective and providers who do not meet the requirements of this chapter may continue to receive payment under sections 256S.201 and 256S.202, as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved Elderly Home and Community Based Services Waiver Program (Control Number 0025.91). Providers of assisted living for the community access for disability inclusion (CADI) and Brain Injury (BI) waivers shall continue to receive payment as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved CADI and BI waiver plans. History: 2006 c 282 art 19 s 17; 2012 c 216 art 14 s 2; 2015 c 78 art 6 s 31; 2019 c 54 art 2 s 4; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.06 UNIFORM CONSUMER INFORMATION GUIDE. The commissioner shall adopt a uniform format for the guide to be used by individual providers, and the required components of materials to be used by providers to inform assisted living clients of their legal rights, and shall make the uniform format and the required components available to assisted living providers. History: 2006 c 282 art 19 s 18; 1Sp2010 c 1 art 17 s 5; 2014 c 286 art 7 s 3; 2019 c 60 art 1 s 48 NOTE: This section is repealed by Laws 2019, chapter 60, article 1, section 48, effective August 1, 2021. Laws 2019, chapter 60, article 1, section 48. 144G.07 RETALIATION PROHIBITED. Subdivision 1. Definitions. For the purposes of this section: (1) "facility" means a housing with services establishment registered under section 144D.02 and operating under title protection under sections 144G.01 to 144G.07; and (2) "resident" means a resident of a facility. Subd. 2. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the administrator or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law;
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(6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or (9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 3. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; (7) an arbitrary increase in charges or fees; (8) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices; or (9) any oral or written communication of false information about a person advocating on behalf of the resident. Subd. 4. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination.
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Subd. 5. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 3 within 30 days of an initial action described in subdivision 2, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred. History: 2019 c 60 art 3 s 3 NOTE: This section, as added by Laws 2019, chapter 60, article 3, section 3, expires July 31, 2021. Laws 2019, chapter 60, article 3, section 3, the effective date. ASSISTED LIVING LICENSURE 144G.08 DEFINITIONS. Subdivision 1. Applicability. For the purposes of this chapter, the terms in this section have the meanings given. Subd. 2. Adult. "Adult" means a natural person who has attained the age of 18 years. Subd. 3. Advanced practice registered nurse. "Advanced practice registered nurse" has the meaning given in section 148.171, subdivision 3. Subd. 4. Applicant. "Applicant" means an individual, legal entity, or other organization that has applied for licensure under this chapter. Subd. 5. Assisted living contract. "Assisted living contract" means the legal agreement between a resident and an assisted living facility for housing and, if applicable, assisted living services. Subd. 6. Assisted living director. "Assisted living director" means a person who administers, manages, supervises, or is in general administrative charge of an assisted living facility, whether or not the individual has an ownership interest in the facility, and whether or not the person's functions or duties are shared with one or more individuals and who is licensed by the Board of Executives for Long Term Services and Supports pursuant to section 144A.20. Subd. 7. Assisted living facility. "Assisted living facility" means a licensed facility that provides sleeping accommodations and assisted living services to one or more adults. Assisted living facility includes assisted living facility with dementia care, and does not include: (1) emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals, as defined under section 116L.361; (2) a nursing home licensed under chapter 144A; (3) a hospital, certified boarding care, or supervised living facility licensed under sections 144.50 to 144.56; (4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts 9520.0500 to 9520.0670, or under chapter 245D or 245G; (5) services and residential settings licensed under chapter 245A, including adult foster care and services and settings governed under the standards in chapter 245D;
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(6) a private home in which the residents are related by kinship, law, or affinity with the provider of services; (7) a duly organized condominium, cooperative, and common interest community, or owners' association of the condominium, cooperative, and common interest community where at least 80 percent of the units that comprise the condominium, cooperative, or common interest community are occupied by individuals who are the owners, members, or shareholders of the units; (8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593; (9) a setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing; (10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services; (11) rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q; (12) rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56; (13) rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011; or (14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b). Subd. 8. Assisted living facility with dementia care. "Assisted living facility with dementia care" means a licensed assisted living facility that is advertised, marketed, or otherwise promoted as providing specialized care for individuals with Alzheimer's disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care. Subd. 9. Assisted living services. "Assisted living services" includes one or more of the following: (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing; (2) providing standby assistance; (3) providing verbal or visual reminders to the resident to take regularly scheduled medication, which includes bringing the resident previously set up medication, medication in original containers, or liquid or food to accompany the medication; (4) providing verbal or visual reminders to the resident to perform regularly scheduled treatments and exercises; (5) preparing modified diets ordered by a licensed health professional; (6) services of an advanced practice registered nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker;
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(7) tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person's scope of practice; (8) medication management services; (9) hands-on assistance with transfers and mobility; (10) treatment and therapies; (11) assisting residents with eating when the residents have complicated eating problems as identified in the resident record or through an assessment such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be fed; (12) providing other complex or specialty health care services; and (13) supportive services in addition to the provision of at least one of the services listed in clauses (1) to (12). Subd. 10. Authority having jurisdiction. "Authority having jurisdiction" means an organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure. Subd. 11. Authorized agent. "Authorized agent" means the person who is authorized to accept service of notices and orders on behalf of the licensee. Subd. 12. Change of ownership. "Change of ownership" means a change in the licensee that is responsible for the management, control, and operation of a facility. Subd. 13. Commissioner. "Commissioner" means the commissioner of health. Subd. 14. Controlled substance. "Controlled substance" has the meaning given in section 152.01, subdivision 4. Subd. 15. Controlling individual. (a) "Controlling individual" means an owner and the following individuals and entities, if applicable: (1) each officer of the organization, including the chief executive officer and chief financial officer; (2) each managerial official; and (3) any entity with at least a five percent mortgage, deed of trust, or other security interest in the facility. (b) Controlling individual does not include: (1) a bank, savings bank, trust company, savings association, credit union, industrial loan and thrift company, investment banking firm, or insurance company unless the entity operates a program directly or through a subsidiary; (2) government and government-sponsored entities such as the U.S. Department of Housing and Urban Development, Ginnie Mae, Fannie Mae, Freddie Mac, and the Minnesota Housing Finance Agency which provide loans, financing, and insurance products for housing sites; (3) an individual who is a state or federal official, a state or federal employee, or a member or employee of the governing body of a political subdivision of the state or federal government that operates one or more
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facilities, unless the individual is also an officer, owner, or managerial official of the facility, receives remuneration from the facility, or owns any of the beneficial interests not excluded in this subdivision; (4) an individual who owns less than five percent of the outstanding common shares of a corporation: (i) whose securities are exempt under section 80A.45, clause (6); or (ii) whose transactions are exempt under section 80A.46, clause (2); (5) an individual who is a member of an organization exempt from taxation under section 290.05, unless the individual is also an officer, owner, or managerial official of the license or owns any of the beneficial interests not excluded in this subdivision. This clause does not exclude from the definition of controlling individual an organization that is exempt from taxation; or (6) an employee stock ownership plan trust, or a participant or board member of an employee stock ownership plan, unless the participant or board member is a controlling individual. Subd. 16. Dementia. "Dementia" means the loss of cognitive function, including the ability to think, remember, problem solve, or reason, of sufficient severity to interfere with an individual's daily functioning. Dementia is caused by different diseases and conditions, including but not limited to Alzheimer's disease, vascular dementia, neurodegenerative conditions, Creutzfeldt-Jakob disease, and Huntington's disease. Subd. 17. Dementia care services. "Dementia care services" means ongoing care for behavioral and psychological symptoms of dementia, including planned group and individual programming and person-centered care practices provided according to section 144G.84 to support activities of daily living for people living with dementia. Subd. 18. Dementia-trained staff. "Dementia-trained staff" means any employee who has completed the minimum training required under sections 144G.64 and 144G.83 and has demonstrated knowledge and the ability to support individuals with dementia. Subd. 19. Designated representative. "Designated representative" means a person designated under section 144G.50. Subd. 20. Dietary supplement. "Dietary supplement" means a product taken by mouth that contains a dietary ingredient intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissue, glandulars, or metabolites. Subd. 21. Dietitian. "Dietitian" means a person licensed as a dietitian under section 148.624. Subd. 22. Direct contact. "Direct contact" means providing face-to-face care, training, supervision, counseling, consultation, or medication assistance to residents of a facility. Subd. 23. Direct ownership interest. "Direct ownership interest" means an individual or organization with the possession of at least five percent equity in capital, stock, or profits of the licensee, or who is a member of a limited liability company of the licensee. Subd. 24. Facility. "Facility" means an assisted living facility. Subd. 25. Hands-on assistance. "Hands-on assistance" means physical help by another person without which the resident is not able to perform the activity.
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Subd. 26. "I'm okay" check services. "'I'm okay' check services" means having, maintaining, and documenting a system to, by any means, check on the safety of a resident a minimum of once daily or more frequently according to the assisted living contract. Subd. 27. Indirect ownership interest. "Indirect ownership interest" means an individual or legal entity with a direct ownership interest in an entity that has a direct or indirect ownership interest of at least five percent in an entity that is a licensee. Subd. 28. Legal representative. "Legal representative" means one of the following in the order of priority listed, to the extent the person may reasonably be identified and located: (1) a court-appointed guardian acting in accordance with the powers granted to the guardian under chapter 524; (2) a conservator acting in accordance with the powers granted to the conservator under chapter 524; (3) a health care agent acting in accordance with the powers granted to the health care agent under chapter 145C; or (4) an attorney-in-fact acting in accordance with the powers granted to the attorney-in-fact by a written power of attorney under chapter 523. Subd. 29. Licensed health professional. "Licensed health professional" means a person licensed in Minnesota to practice a profession described in section 214.01, subdivision 2. Subd. 30. Licensed practical nurse. "Licensed practical nurse" has the meaning given in section 148.171, subdivision 8. Subd. 31. Licensed resident capacity. "Licensed resident capacity" means the resident occupancy level requested by a licensee and approved by the commissioner. Subd. 32. Licensee. "Licensee" means a person or legal entity to whom the commissioner issues a license for an assisted living facility and who is responsible for the management, control, and operation of a facility. Subd. 33. Maltreatment. "Maltreatment" means conduct described in section 626.5572, subdivision 15. Subd. 34. Management agreement. "Management agreement" means a written, executed agreement between a licensee and manager regarding the provision of certain services on behalf of the licensee. Subd. 35. Manager. "Manager" means an individual or legal entity designated by the licensee through a management agreement to act on behalf of the licensee in the on-site management of the assisted living facility. Subd. 36. Managerial official. "Managerial official" means an individual who has the decision-making authority related to the operation of the facility and the responsibility for the ongoing management or direction of the policies, services, or employees of the facility. Subd. 37. Medication. "Medication" means a prescription or over-the-counter drug. For purposes of this chapter only, medication includes dietary supplements. Subd. 38. Medication administration. "Medication administration" means performing a set of tasks that includes the following:
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(1) checking the resident's medication record; (2) preparing the medication as necessary; (3) administering the medication to the resident; (4) documenting the administration or reason for not administering the medication; and (5) reporting to a registered nurse or appropriate licensed health professional any concerns about the medication, the resident, or the resident's refusal to take the medication. Subd. 39. Medication management. "Medication management" means the provision of any of the following medication-related services to a resident: (1) performing medication setup; (2) administering medications; (3) storing and securing medications; (4) documenting medication activities; (5) verifying and monitoring the effectiveness of systems to ensure safe handling and administration; (6) coordinating refills; (7) handling and implementing changes to prescriptions; (8) communicating with the pharmacy about the resident's medications; and (9) coordinating and communicating with the prescriber. Subd. 40. Medication reconciliation. "Medication reconciliation" means the process of identifying the most accurate list of all medications the resident is taking, including the name, dosage, frequency, and route, by comparing the resident record to an external list of medications obtained from the resident, hospital, prescriber, or other provider. Subd. 41. Medication setup. "Medication setup" means arranging medications by a nurse, pharmacy, or authorized prescriber for later administration by the resident or by facility staff. Subd. 42. New construction. "New construction" means a new building, renovation, modification, reconstruction, physical changes altering the use of occupancy, or addition to a building. Subd. 43. Nurse. "Nurse" means a person who is licensed under sections 148.171 to 148.285. Subd. 44. Nutritionist. "Nutritionist" means a person licensed as a nutritionist under section 148.624. Subd. 45. Occupational therapist. "Occupational therapist" means a person who is licensed under sections 148.6401 to 148.6449. Subd. 46. Ombudsman. "Ombudsman" means the ombudsman for long-term care. Subd. 47. Over-the-counter drug. "Over-the-counter drug" means a drug that is not required by federal law to bear the symbol "Rx only."
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Subd. 48. Owner. "Owner" means an individual or legal entity that has a direct or indirect ownership interest of five percent or more in a licensee. For purposes of this chapter, "owner of a nonprofit corporation" means the president and treasurer of the board of directors or, for an entity owned by an employee stock ownership plan, means the president and treasurer of the entity. A government entity that is issued a license under this chapter shall be designated the owner. Subd. 49. Person-centered planning and service delivery. "Person-centered planning and service delivery" means services as defined in section 245D.07, subdivision 1a, paragraph (b). Subd. 50. Pharmacist. "Pharmacist" has the meaning given in section 151.01, subdivision 3. Subd. 51. Physical therapist. "Physical therapist" means a person who is licensed under sections 148.65 to 148.78. Subd. 52. Physician. "Physician" means a person who is licensed under chapter 147. Subd. 53. Prescriber. "Prescriber" means a person who is authorized by section 148.235; 151.01, subdivision 23; or 151.37 to prescribe prescription drugs. Subd. 54. Prescription. "Prescription" has the meaning given in section 151.01, subdivision 16a. Subd. 55. Provisional license. "Provisional license" means the initial license the commissioner issues after approval of a complete written application and before the commissioner completes the provisional license survey and determines that the provisional licensee is in substantial compliance. Subd. 56. Regularly scheduled. "Regularly scheduled" means ordered or planned to be completed at predetermined times or according to a predetermined routine. Subd. 57. Reminder. "Reminder" means providing a verbal or visual reminder to a resident. Subd. 58. Repeat violation. "Repeat violation" means the issuance of two or more correction orders within a 12-month period for a violation of the same provision of a statute or rule. Subd. 59. Resident. "Resident" means a person living in an assisted living facility who has executed an assisted living contract. Subd. 60. Resident record. "Resident record" means all records that document information about the services provided to the resident. Subd. 61. Respiratory therapist. "Respiratory therapist" means a person who is licensed under chapter 147C. Subd. 62. Secured dementia care unit. "Secured dementia care unit" means a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident's ability to exit, the secured area or setting. A secured dementia care unit is not solely an individual resident's living area. Subd. 63. Service plan. "Service plan" means the written plan between the resident and the provisional licensee or licensee about the services that will be provided to the resident. Subd. 64. Social worker. "Social worker" means a person who is licensed under chapter 148D or 148E. Subd. 65. Speech-language pathologist. "Speech-language pathologist" has the meaning given in section 148.512, subdivision 17.
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Subd. 66. Standby assistance. "Standby assistance" means the presence of another person within arm's reach to minimize the risk of injury while performing daily activities through physical intervention or cueing to assist a resident with an assistive task by providing cues, oversight, and minimal physical assistance. Subd. 67. Substantial compliance. "Substantial compliance" means complying with the requirements in this chapter sufficiently to prevent unacceptable health or safety risks to residents. Subd. 68. Supportive services. "Supportive services" means: (1) assistance with laundry, shopping, and household chores; (2) housekeeping services; (3) provision or assistance with meals or food preparation; (4) help with arranging for, or arranging transportation to, medical, social, recreational, personal, or social services appointments; (5) provision of social or recreational services; or (6) "I'm okay" check services. Arranging for services does not include making referrals, or contacting a service provider in an emergency. Subd. 69. Survey. "Survey" means an inspection of a licensee or applicant for licensure for compliance with this chapter and applicable rules. Subd. 70. Surveyor. "Surveyor" means a staff person of the department who is authorized to conduct surveys of assisted living facilities. Subd. 71. Treatment or therapy. "Treatment" or "therapy" means the provision of care, other than medications, ordered or prescribed by a licensed health professional and provided to a resident to cure, rehabilitate, or ease symptoms. Subd. 72. Unit of government. "Unit of government" means a city, county, town, school district, other political subdivision of the state, or agency of the state or federal government, that includes any instrumentality of a unit of government. Subd. 73. Unlicensed personnel. "Unlicensed personnel" means individuals not otherwise licensed or certified by a governmental health board or agency who provide services to a resident. Subd. 74. Verbal. "Verbal" means oral and not in writing. History: 2019 c 60 art 1 s 2,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 2, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 2, the effective date. 144G.09 COMMISSIONER OVERSIGHT AND AUTHORITY OVER ASSISTED LIVING FACILITIES. Subdivision 1. Regulations. The commissioner shall regulate assisted living facilities pursuant to this chapter. The regulations shall include the following:
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(1) provisions to assure, to the extent possible, the health, safety, well-being, and appropriate treatment of residents while respecting individual autonomy and choice; (2) requirements that facilities furnish the commissioner with specified information necessary to implement this chapter; (3) standards of training of facility personnel; (4) standards for the provision of assisted living services; (5) standards for medication management; (6) standards for supervision of assisted living services; (7) standards for resident evaluation or assessment; (8) standards for treatments and therapies; (9) requirements for the involvement of a resident's health care provider, the documentation of the health care provider's orders, if required, and the resident's service plan; (10) standards for the maintenance of accurate, current resident records; (11) the establishment of levels of licenses based on services provided; and (12) provisions to enforce these regulations and the assisted living bill of rights. [See Note.] Subd. 2. Regulatory functions. (a) The commissioner shall: (1) license, survey, and monitor without advance notice assisted living facilities in accordance with this chapter and rules; (2) survey every provisional licensee within one year of the provisional license issuance date subject to the provisional licensee providing assisted living services to residents; (3) survey assisted living facility licensees at least once every two years; (4) investigate complaints of assisted living facilities; (5) issue correction orders and assess civil penalties under sections 144G.30 and 144G.31; (6) take action as authorized in section 144G.20; and (7) take other action reasonably required to accomplish the purposes of this chapter. (b) The commissioner shall review blueprints for all new facility construction and must approve the plans before construction may be commenced. (c) The commissioner shall provide on-site review of the construction to ensure that all physical environment standards are met before the facility license is complete. [See Note.]
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Subd. 3. Rulemaking authorized. (a) The commissioner shall adopt rules for all assisted living facilities that promote person-centered planning and service delivery and optimal quality of life, and that ensure resident rights are protected, resident choice is allowed, and public health and safety is ensured. (b) On July 1, 2019, the commissioner shall begin rulemaking. (c) The commissioner shall adopt rules that include but are not limited to the following: (1) staffing appropriate for each licensure category to best protect the health and safety of residents no matter their vulnerability; (2) training prerequisites and ongoing training, including dementia care training and standards for demonstrating competency; (3) procedures for discharge planning and ensuring resident appeal rights; (4) initial assessments, continuing assessments, and a uniform assessment tool; (5) emergency disaster and preparedness plans; (6) uniform checklist disclosure of services; (7) a definition of serious injury that results from maltreatment; (8) conditions and fine amounts for planned closures; (9) procedures and timelines for the commissioner regarding termination appeals between facilities and the Office of Administrative Hearings; (10) establishing base fees and per-resident fees for each category of licensure; (11) considering the establishment of a maximum amount for any one fee; (12) procedures for relinquishing an assisted living facility with dementia care license and fine amounts for noncompliance; and (13) procedures to efficiently transfer existing housing with services registrants and home care licensees to the new assisted living facility licensure structure. (d) The commissioner shall publish the proposed rules by December 31, 2019, and shall publish final rules by December 31, 2020. History: 2019 c 60 art 1 s 34,41,47 NOTE: Subdivisions 1 and 2, as added by Laws 2019, chapter 60, article 1, section 34, are effective August 1, 2021. Laws 2019, chapter 60, article 1, section 34, the effective date. 144G.10 ASSISTED LIVING FACILITY LICENSE. Subdivision 1. License required. Beginning August 1, 2021, no assisted living facility may operate in Minnesota unless it is licensed under this chapter. The licensee is legally responsible for the management, control, and operation of the facility, regardless of the existence of a management agreement or subcontract. Nothing in this chapter shall in any way affect the rights and remedies available under other law. Subd. 2. Licensure categories. (a) The categories in this subdivision are established for assisted living facility licensure.
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144G.12
(1) The assisted living facility category is for assisted living facilities that only provide assisted living services. (2) The assisted living facility with dementia care category is for assisted living facilities that provide assisted living services and dementia care services. An assisted living facility with dementia care may also provide dementia care services in a secured dementia care unit. (b) An assisted living facility that has a secured dementia care unit must be licensed as an assisted living facility with dementia care. Subd. 3. Licensure under other law. An assisted living facility licensed under this chapter is not required to also be licensed as a boarding establishment, food and beverage service establishment, hotel, motel, lodging establishment, resort, or restaurant under chapter 157. Subd. 4. Violations; penalty. (a) Operating an assisted living facility without a license is a misdemeanor, and the commissioner may also impose a fine. (b) A controlling individual of the facility in violation of this section is guilty of a misdemeanor. This paragraph shall not apply to any controlling individual who had no legal authority to affect or change decisions related to the operation of the facility. (c) The sanctions in this section do not restrict other available sanctions in law. History: 2019 c 60 art 1 s 3,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 3, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 3, the effective date. 144G.11 APPLICABILITY OF OTHER LAWS. Assisted living facilities: (1) are subject to and must comply with chapter 504B; (2) must comply with section 325F.72; and (3) are not required to obtain a lodging license under chapter 157 and related rules. History: 2019 c 60 art 1 s 44,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 44, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 44, the effective date. 144G.12 APPLICATION FOR LICENSURE. Subdivision 1. License applications. Each application for an assisted living facility license, including provisional and renewal applications, must include information sufficient to show that the applicant meets the requirements of licensure, including: (1) the business name and legal entity name of the licensee, and the street address and mailing address of the facility; (2) the names, e-mail addresses, telephone numbers, and mailing addresses of all owners, controlling individuals, managerial officials, and the assisted living director;
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(3) the name and e-mail address of the managing agent and manager, if applicable; (4) the licensed resident capacity and the license category; (5) the license fee in the amount specified in section 144.122; (6) documentation of compliance with the background study requirements in section 144G.13 for the owner, controlling individuals, and managerial officials. Each application for a new license must include documentation for the applicant and for each individual with five percent or more direct or indirect ownership in the applicant; (7) evidence of workers' compensation coverage as required by sections 176.181 and 176.182; (8) documentation that the facility has liability coverage; (9) a copy of the executed lease agreement between the landlord and the licensee, if applicable; (10) a copy of the management agreement, if applicable; (11) a copy of the operations transfer agreement or similar agreement, if applicable; (12) an organizational chart that identifies all organizations and individuals with an ownership interest in the licensee of five percent or greater and that specifies their relationship with the licensee and with each other; (13) whether the applicant, owner, controlling individual, managerial official, or assisted living director of the facility has ever been convicted of: (i) a crime or found civilly liable for a federal or state felony level offense that was detrimental to the best interests of the facility and its resident within the last ten years preceding submission of the license application. Offenses include: felony crimes against persons and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions; financial crimes such as extortion, embezzlement, income tax evasion, insurance fraud, and other similar crimes for which the individual was convicted, including guilty pleas and adjudicated pretrial diversions; any felonies involving malpractice that resulted in a conviction of criminal neglect or misconduct; and any felonies that would result in a mandatory exclusion under section 1128(a) of the Social Security Act; (ii) any misdemeanor conviction, under federal or state law, related to: the delivery of an item or service under Medicaid or a state health care program, or the abuse or neglect of a patient in connection with the delivery of a health care item or service; (iii) any misdemeanor conviction, under federal or state law, related to theft, fraud, embezzlement, breach of fiduciary duty, or other financial misconduct in connection with the delivery of a health care item or service; (iv) any felony or misdemeanor conviction, under federal or state law, relating to the interference with or obstruction of any investigation into any criminal offense described in Code of Federal Regulations, title 42, section 1001.101 or 1001.201; (v) any felony or misdemeanor conviction, under federal or state law, relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance; (vi) any felony or gross misdemeanor that relates to the operation of a nursing home or assisted living facility or directly affects resident safety or care during that period;
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(vii) any revocation or suspension of a license to provide health care by any state licensing authority. This includes the surrender of such a license while a formal disciplinary proceeding was pending before a state licensing authority; (viii) any revocation or suspension of accreditation; or (ix) any suspension or exclusion from participation in, or any sanction imposed by, a federal or state health care program, or any debarment from participation in any federal executive branch procurement or nonprocurement program; (14) whether, in the preceding three years, the applicant or any owner, controlling individual, managerial official, or assisted living director of the facility has a record of defaulting in the payment of money collected for others, including the discharge of debts through bankruptcy proceedings; (15) the signature of the owner of the licensee, or an authorized agent of the licensee; (16) identification of all states where the applicant or individual having a five percent or more ownership, currently or previously has been licensed as an owner or operator of a long-term care, community-based, or health care facility or agency where its license or federal certification has been denied, suspended, restricted, conditioned, refused, not renewed, or revoked under a private or state-controlled receivership, or where these same actions are pending under the laws of any state or federal authority; (17) statistical information required by the commissioner; and (18) any other information required by the commissioner. Subd. 2. Authorized agents. (a) An application for an assisted living facility license or for renewal of a facility license must specify one or more owners, controlling individuals, or employees as authorized agents who can accept service on behalf of the licensee in proceedings under this chapter. (b) Notwithstanding any law to the contrary, personal service on the authorized agent named in the application is deemed to be service on all of the controlling individuals or managerial officials of the facility, and it is not a defense to any action arising under this chapter that personal service was not made on each controlling individual or managerial official of the facility. The designation of one or more controlling individuals or managerial officials under this subdivision shall not affect the legal responsibility of any other controlling individual or managerial official under this chapter. Subd. 3. Fees. (a) An initial applicant, renewal applicant, or applicant filing a change of ownership for assisted living facility licensure must submit the application fee required in section 144.122 to the commissioner along with a completed application. (b) Fees collected under this section shall be deposited in the state treasury and credited to the state government special revenue fund. All fees are nonrefundable. Subd. 4. Fines and penalties. (a) The penalty for late submission of the renewal application less than 30 days before the expiration date of the license or after expiration of the license is $200. The penalty for operating a facility after expiration of the license and before a renewal license is issued is $250 each day after expiration of the license until the renewal license issuance date. The facility is still subject to the misdemeanor penalties for operating after license expiration.
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(b) Fines and penalties collected under this subdivision shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner to implement the recommendations of the advisory council established in section 144A.4799. History: 2019 c 60 art 1 s 5,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 5, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 5, the effective date. 144G.13 BACKGROUND STUDIES OF LICENSE APPLICANTS. Subdivision 1. Background studies required. (a) Before the commissioner issues a provisional license, issues a license as a result of an approved change of ownership, or renews a license, a managerial official or a natural person who is an owner with direct ownership interest is required to undergo a background study under section 144.057. No person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C. For the purposes of this section, managerial officials subject to the background study requirement are individuals who provide direct contact. Nothing in this section shall be construed to prohibit the facility from requiring self-disclosure of criminal conviction information. (b) The commissioner shall not issue a license if any controlling individual, including a managerial official, has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C. (c) Termination of an employee in good faith reliance on information or records obtained under this section regarding a confirmed conviction does not subject the assisted living facility to civil liability or liability for unemployment benefits. Subd. 2. Reconsideration. (a) If the individual requests reconsideration of a disqualification under section 144.057 or chapter 245C and the commissioner sets aside or rescinds the disqualification, the individual is eligible to be involved in the management, operation, or control of the facility. (b) If an individual has a disqualification under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's disqualification is barred from a set aside, and the individual must not be involved in the management, operation, or control of the facility. Subd. 3. Data classification. Data collected under this section shall be classified as private data on individuals under section 13.02, subdivision 12. History: 2019 c 60 art 1 s 7,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 7, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 7, the effective date. 144G.15 CONSIDERATION OF APPLICATIONS. (a) Before issuing a provisional license or license or renewing a license, the commissioner shall consider an applicant's compliance history in providing care in a facility that provides care to children, the elderly, ill individuals, or individuals with disabilities. (b) The applicant's compliance history shall include repeat violation, rule violations, and any license or certification involuntarily suspended or terminated during an enforcement process.
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(c) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license or impose conditions if: (1) the applicant fails to provide complete and accurate information on the application and the commissioner concludes that the missing or corrected information is needed to determine if a license shall be granted; (2) the applicant, knowingly or with reason to know, made a false statement of a material fact in an application for the license or any data attached to the application or in any matter under investigation by the department; (3) the applicant refused to allow agents of the commissioner to inspect its books, records, and files related to the license application, or any portion of the premises; (4) the applicant willfully prevented, interfered with, or attempted to impede in any way: (i) the work of any authorized representative of the commissioner, the ombudsman for long-term care, or the ombudsman for mental health and developmental disabilities; or (ii) the duties of the commissioner, local law enforcement, city or county attorneys, adult protection, county case managers, or other local government personnel; (5) the applicant has a history of noncompliance with federal or state regulations that were detrimental to the health, welfare, or safety of a resident or a client; or (6) the applicant violates any requirement in this chapter. (d) If a license is denied, the applicant has the reconsideration rights available under section 144G.16, subdivision 4. History: 2019 c 60 art 1 s 10,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 10, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 10, the effective date. 144G.16 PROVISIONAL LICENSE. Subdivision 1. Provisional license. Beginning August 1, 2021, for new assisted living facility license applicants, the commissioner shall issue a provisional license from one of the licensure categories specified in section 144G.10, subdivision 2. A provisional license is effective for up to one year from the initial effective date of the license, except that a provisional license may be extended according to subdivisions 2, paragraph (d), and 3. Subd. 2. Initial survey. (a) During the provisional license period, the commissioner shall survey the provisional licensee after the commissioner is notified or has evidence that the provisional licensee is providing assisted living services to at least one resident. (b) Within two days of beginning to provide assisted living services, the provisional licensee must provide notice to the commissioner that it is providing assisted living services by sending an e-mail to the e-mail address provided by the commissioner. (c) If the provisional licensee does not provide services during the provisional license period, the provisional license shall expire at the end of the period and the applicant must reapply. (d) If the provisional licensee notifies the commissioner that the licensee is providing assisted living services within 45 calendar days prior to expiration of the provisional license, the commissioner may extend
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the provisional license for up to 60 calendar days in order to allow the commissioner to complete the on-site survey required under this section and follow-up survey visits. Subd. 3. Licensure; termination or extension of provisional licenses. (a) If the provisional licensee is in substantial compliance with the survey, the commissioner shall issue a facility license. (b) If the provisional licensee is not in substantial compliance with the initial survey, the commissioner shall either: (1) not issue the facility license and terminate the provisional license; or (2) extend the provisional license for a period not to exceed 90 calendar days and apply conditions necessary to bring the facility into substantial compliance. If the provisional licensee is not in substantial compliance with the survey within the time period of the extension or if the provisional licensee does not satisfy the license conditions, the commissioner may deny the license. Subd. 4. Reconsideration. (a) If a provisional licensee whose assisted living facility license has been denied or extended with conditions disagrees with the conclusions of the commissioner, then the provisional licensee may request a reconsideration by the commissioner. The reconsideration request process must be conducted internally by the commissioner and chapter 14 does not apply. (b) The provisional licensee requesting the reconsideration must make the request in writing and must list and describe the reasons why the provisional licensee disagrees with the decision to deny the facility license or the decision to extend the provisional license with conditions. (c) The reconsideration request and supporting documentation must be received by the commissioner within 15 calendar days after the date the provisional licensee receives the denial or provisional license with conditions. Subd. 5. Continued operation. A provisional licensee whose license is denied is permitted to continue operating during the period of time when: (1) a reconsideration is in process; (2) an extension of the provisional license and terms associated with it is in active negotiation between the commissioner and the licensee, and the commissioner confirms the negotiation is active; or (3) a transfer of residents to a new facility is underway and not all of the residents have relocated. Subd. 6. Requirements for notice and transfer. A provisional licensee whose license is denied must comply with the requirements for notification and the coordinated move of residents in sections 144G.52 and 144G.55. Subd. 7. Fines. The fee for failure to comply with the notification requirements in section 144G.52, subdivision 7, is $1,000. History: 2019 c 60 art 1 s 4,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 4, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 4, the effective date. 144G.17 LICENSE RENEWAL. A license that is not a provisional license may be renewed for a period of up to one year if the licensee: (1) submits an application for renewal in the format provided by the commissioner at least 60 calendar days before expiration of the license;
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(2) submits the renewal fee under section 144G.12, subdivision 3; (3) submits the late fee under section 144G.12, subdivision 4, if the renewal application is received less than 30 days before the expiration date of the license or after the expiration of the license; (4) provides information sufficient to show that the applicant meets the requirements of licensure, including items required under section 144G.12, subdivision 1; and (5) provides any other information deemed necessary by the commissioner. History: 2019 c 60 art 1 s 8,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 8, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 8, the effective date. 144G.18 NOTIFICATION OF CHANGES IN INFORMATION. A provisional licensee or licensee shall notify the commissioner in writing prior to a change in the manager or authorized agent and within 60 calendar days after any change in the information required in section 144G.12, subdivision 1, paragraph (a), clause (1), (3), (4), (17), or (18). History: 2019 c 60 art 1 s 9,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 9, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 9, the effective date. 144G.19 TRANSFER OF LICENSE PROHIBITED. Subdivision 1. Transfers prohibited. An assisted living facility license may not be transferred to another party. Subd. 2. New license required. (a) A prospective licensee must apply for a license prior to operating a currently licensed assisted living facility. The new license, if issued, shall not be a provisional license. The licensee must change whenever one of the following events occur: (1) the form of the licensee's legal entity structure is converted or changed to a different type of legal entity structure; (2) the licensee dissolves, consolidates, or merges with another legal organization and the licensee's legal organization does not survive; (3) within the previous 24 months, 50 percent or more of the licensee is transferred, whether by a single transaction or multiple transactions, to: (i) a different person; or (ii) a person who had less than a five percent ownership interest in the facility at the time of the first transaction; or (4) any other event or combination of events that results in a substitution, elimination, or withdrawal of the licensee's responsibility for the facility. (b) The prospective licensee must provide written notice to the department at least 60 calendar days prior to the anticipated date of the change of licensee.
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Subd. 3. Survey required. For all new licensees after a change of ownership, the commissioner shall complete a survey within six months after the new license is issued. History: 2019 c 60 art 1 s 6,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 6, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 6, the effective date. ENFORCEMENT 144G.20 ENFORCEMENT. Subdivision 1. Conditions. (a) The commissioner may refuse to grant a provisional license, refuse to grant a license as a result of a change in ownership, refuse to renew a license, suspend or revoke a license, or impose a conditional license if the owner, controlling individual, or employee of an assisted living facility: (1) is in violation of, or during the term of the license has violated, any of the requirements in this chapter or adopted rules; (2) permits, aids, or abets the commission of any illegal act in the provision of assisted living services; (3) performs any act detrimental to the health, safety, and welfare of a resident; (4) obtains the license by fraud or misrepresentation; (5) knowingly makes a false statement of a material fact in the application for a license or in any other record or report required by this chapter; (6) denies representatives of the department access to any part of the facility's books, records, files, or employees; (7) interferes with or impedes a representative of the department in contacting the facility's residents; (8) interferes with or impedes ombudsman access according to section 256.9742, subdivision 4; (9) interferes with or impedes a representative of the department in the enforcement of this chapter or fails to fully cooperate with an inspection, survey, or investigation by the department; (10) destroys or makes unavailable any records or other evidence relating to the assisted living facility's compliance with this chapter; (11) refuses to initiate a background study under section 144.057 or 245A.04; (12) fails to timely pay any fines assessed by the commissioner; (13) violates any local, city, or township ordinance relating to housing or assisted living services; (14) has repeated incidents of personnel performing services beyond their competency level; or (15) has operated beyond the scope of the assisted living facility's license category. (b) A violation by a contractor providing the assisted living services of the facility is a violation by the facility.
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Subd. 2. Terms to suspension or conditional license. (a) A suspension or conditional license designation may include terms that must be completed or met before a suspension or conditional license designation is lifted. A conditional license designation may include restrictions or conditions that are imposed on the assisted living facility. Terms for a suspension or conditional license may include one or more of the following and the scope of each will be determined by the commissioner: (1) requiring a consultant to review, evaluate, and make recommended changes to the facility's practices and submit reports to the commissioner at the cost of the facility; (2) requiring supervision of the facility or staff practices at the cost of the facility by an unrelated person who has sufficient knowledge and qualifications to oversee the practices and who will submit reports to the commissioner; (3) requiring the facility or employees to obtain training at the cost of the facility; (4) requiring the facility to submit reports to the commissioner; (5) prohibiting the facility from admitting any new residents for a specified period of time; or (6) any other action reasonably required to accomplish the purpose of this subdivision and subdivision 1. (b) A facility subject to this subdivision may continue operating during the period of time residents are being transferred to another service provider. Subd. 3. Immediate temporary suspension. (a) In addition to any other remedies provided by law, the commissioner may, without a prior contested case hearing, immediately temporarily suspend a license or prohibit delivery of housing or services by a facility for not more than 90 calendar days or issue a conditional license, if the commissioner determines that there are: (1) Level 4 violations; or (2) violations that pose an imminent risk of harm to the health or safety of residents. (b) For purposes of this subdivision, "Level 4" has the meaning given in section 144G.31. (c) A notice stating the reasons for the immediate temporary suspension or conditional license and informing the licensee of the right to an expedited hearing under subdivision 17 must be delivered by personal service to the address shown on the application or the last known address of the licensee. The licensee may appeal an order immediately temporarily suspending a license or issuing a conditional license. The appeal must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the commissioner within five calendar days after the licensee receives notice. If an appeal is made by personal service, it must be received by the commissioner within five calendar days after the licensee received the order. (d) A licensee whose license is immediately temporarily suspended must comply with the requirements for notification and transfer of residents in subdivision 15. The requirements in subdivision 9 remain if an appeal is requested. Subd. 4. Mandatory revocation. Notwithstanding the provisions of subdivision 13, paragraph (a), the commissioner must revoke a license if a controlling individual of the facility is convicted of a felony or gross misdemeanor that relates to operation of the facility or directly affects resident safety or care. The
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commissioner shall notify the facility and the Office of Ombudsman for Long-Term Care 30 calendar days in advance of the date of revocation. Subd. 5. Owners and managerial officials; refusal to grant license. (a) The owners and managerial officials of a facility whose Minnesota license has not been renewed or whose Minnesota license has been revoked because of noncompliance with applicable laws or rules shall not be eligible to apply for nor will be granted an assisted living facility license under this chapter or a home care provider license under chapter 144A, or be given status as an enrolled personal care assistance provider agency or personal care assistant by the Department of Human Services under section 256B.0659, for five years following the effective date of the nonrenewal or revocation. If the owners or managerial officials already have enrollment status, the Department of Human Services shall terminate that enrollment. (b) The commissioner shall not issue a license to a facility for five years following the effective date of license nonrenewal or revocation if the owners or managerial officials, including any individual who was an owner or managerial official of another licensed provider, had a Minnesota license that was not renewed or was revoked as described in paragraph (a). (c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall suspend or revoke, the license of a facility that includes any individual as an owner or managerial official who was an owner or managerial official of a facility whose Minnesota license was not renewed or was revoked as described in paragraph (a) for five years following the effective date of the nonrenewal or revocation. (d) The commissioner shall notify the facility 30 calendar days in advance of the date of nonrenewal, suspension, or revocation of the license. Subd. 6. Requesting a stay of adverse actions required by owners and managerial officials restrictions. Within ten business days after the receipt of the notification, the facility may request, in writing, that the commissioner stay the nonrenewal, revocation, or suspension of the license. The facility shall specify the reasons for requesting the stay; the steps that will be taken to attain or maintain compliance with the licensure laws and regulations; any limits on the authority or responsibility of the owners or managerial officials whose actions resulted in the notice of nonrenewal, revocation, or suspension; and any other information to establish that the continuing affiliation with these individuals will not jeopardize resident health, safety, or well-being. Subd. 7. Granting a stay of adverse actions required by owners and managerial officials restrictions. The commissioner shall determine whether the stay will be granted within 30 calendar days of receiving the facility's request. The commissioner may propose additional restrictions or limitations on the facility's license and require that granting the stay be contingent upon compliance with those provisions. The commissioner shall take into consideration the following factors when determining whether the stay should be granted: (1) the threat that continued involvement of the owners and managerial officials with the facility poses to resident health, safety, and well-being; (2) the compliance history of the facility; and (3) the appropriateness of any limits suggested by the facility. If the commissioner grants the stay, the order shall include any restrictions or limitation on the provider's license. The failure of the facility to comply with any restrictions or limitations shall result in the immediate removal of the stay and the commissioner shall take immediate action to suspend, revoke, or not renew the license.
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Subd. 8. Controlling individual restrictions. (a) The commissioner has discretion to bar any controlling individual of a facility if the person was a controlling individual of any other nursing home or assisted living facility in the previous two-year period and: (1) during that period of time the nursing home or assisted living facility incurred the following number of uncorrected or repeated violations: (i) two or more repeated violations that created an imminent risk to direct resident care or safety; or (ii) four or more uncorrected violations that created an imminent risk to direct resident care or safety; or (2) during that period of time, was convicted of a felony or gross misdemeanor that related to the operation of the nursing home or assisted living facility, or directly affected resident safety or care. (b) When the commissioner bars a controlling individual under this subdivision, the controlling individual may appeal the commissioner's decision under chapter 14. Subd. 9. Exception to controlling individual restrictions. Subdivision 8 does not apply to any controlling individual of the facility who had no legal authority to affect or change decisions related to the operation of the nursing home or assisted living facility that incurred the uncorrected violations. Subd. 10. Stay of adverse action required by controlling individual restrictions. (a) In lieu of revoking, suspending, or refusing to renew the license of a facility where a controlling individual was disqualified by subdivision 8, paragraph (a), clause (1), the commissioner may issue an order staying the revocation, suspension, or nonrenewal of the facility's license. The order may but need not be contingent upon the facility's compliance with restrictions and conditions imposed on the license to ensure the proper operation of the facility and to protect the health, safety, comfort, treatment, and well-being of the residents in the facility. The decision to issue an order for a stay must be made within 90 calendar days of the commissioner's determination that a controlling individual of the facility is disqualified by subdivision 8, paragraph (a), clause (1), from operating a facility. (b) In determining whether to issue a stay and to impose conditions and restrictions, the commissioner must consider the following factors: (1) the ability of the controlling individual to operate other facilities in accordance with the licensure rules and laws; (2) the conditions in the nursing home or assisted living facility that received the number and type of uncorrected or repeated violations described in subdivision 8, paragraph (a), clause (1); and (3) the conditions and compliance history of each of the nursing homes and assisted living facilities owned or operated by the controlling individual. (c) The commissioner's decision to exercise the authority under this subdivision in lieu of revoking, suspending, or refusing to renew the license of the facility is not subject to administrative or judicial review. (d) The order for the stay of revocation, suspension, or nonrenewal of the facility license must include any conditions and restrictions on the license that the commissioner deems necessary based on the factors listed in paragraph (b). (e) Prior to issuing an order for stay of revocation, suspension, or nonrenewal, the commissioner shall inform the licensee and the controlling individual in writing of any conditions and restrictions that will be
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imposed. The controlling individual shall, within ten working days, notify the commissioner in writing of a decision to accept or reject the conditions and restrictions. If any of the conditions or restrictions are rejected, the commissioner must either modify the conditions and restrictions or take action to suspend, revoke, or not renew the facility's license. (f) Upon issuance of the order for a stay of revocation, suspension, or nonrenewal, the controlling individual shall be responsible for compliance with the conditions and restrictions. Any time after the conditions and restrictions have been in place for 180 days, the controlling individual may petition the commissioner for removal or modification of the conditions and restrictions. The commissioner must respond to the petition within 30 days of receipt of the written petition. If the commissioner denies the petition, the controlling individual may request a hearing under chapter 14. Any hearing shall be limited to a determination of whether the conditions and restrictions shall be modified or removed. At the hearing, the controlling individual bears the burden of proof. (g) The failure of the controlling individual to comply with the conditions and restrictions contained in the order for stay shall result in the immediate removal of the stay and the commissioner shall take action to suspend, revoke, or not renew the license. (h) The conditions and restrictions are effective for two years after the date they are imposed. (i) Nothing in this subdivision shall be construed to limit in any way the commissioner's ability to impose other sanctions against a licensee under the standards in state or federal law whether or not a stay of revocation, suspension, or nonrenewal is issued. Subd. 11. Mandatory proceedings. (a) The commissioner must initiate proceedings within 60 calendar days of notification to suspend or revoke a facility's license or must refuse to renew a facility's license if within the preceding two years the facility has incurred the following number of uncorrected or repeated violations: (1) two or more uncorrected violations or one or more repeated violations that created an imminent risk to direct resident care or safety; or (2) four or more uncorrected violations or two or more repeated violations of any nature for which the fines are in the four highest daily fine categories prescribed in rule. (b) Notwithstanding paragraph (a), the commissioner is not required to revoke, suspend, or refuse to renew a facility's license if the facility corrects the violation. Subd. 12. Notice to residents. (a) Within five business days after proceedings are initiated by the commissioner to revoke or suspend a facility's license, or a decision by the commissioner not to renew a living facility's license, the controlling individual of the facility or a designee must provide to the commissioner and the ombudsman for long-term care the names of residents and the names and addresses of the residents' designated representatives and legal representatives, and family or other contacts listed in the assisted living contract. (b) The controlling individual or designees of the facility must provide updated information each month until the proceeding is concluded. If the controlling individual or designee of the facility fails to provide the information within this time, the facility is subject to the issuance of: (1) a correction order; and (2) a penalty assessment by the commissioner in rule.
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(c) Notwithstanding subdivisions 21 and 22, any correction order issued under this subdivision must require that the facility immediately comply with the request for information and that, as of the date of the issuance of the correction order, the facility shall forfeit to the state a $500 fine the first day of noncompliance and an increase in the $500 fine by $100 increments for each day the noncompliance continues. (d) Information provided under this subdivision may be used by the commissioner or the ombudsman for long-term care only for the purpose of providing affected consumers information about the status of the proceedings. (e) Within ten business days after the commissioner initiates proceedings to revoke, suspend, or not renew a facility license, the commissioner must send a written notice of the action and the process involved to each resident of the facility, legal representatives and designated representatives, and at the commissioner's discretion, additional resident contacts. (f) The commissioner shall provide the ombudsman for long-term care with monthly information on the department's actions and the status of the proceedings. Subd. 13. Notice to facility. (a) Prior to any suspension, revocation, or refusal to renew a license, the facility shall be entitled to notice and a hearing as provided by sections 14.57 to 14.69. The hearing must commence within 60 calendar days after the proceedings are initiated. In addition to any other remedy provided by law, the commissioner may, without a prior contested case hearing, temporarily suspend a license or prohibit delivery of services by a provider for not more than 90 calendar days, or issue a conditional license if the commissioner determines that there are Level 3 violations that do not pose an imminent risk of harm to the health or safety of the facility residents, provided: (1) advance notice is given to the facility; (2) after notice, the facility fails to correct the problem; (3) the commissioner has reason to believe that other administrative remedies are not likely to be effective; and (4) there is an opportunity for a contested case hearing within 30 calendar days unless there is an extension granted by an administrative law judge. (b) If the commissioner determines there are Level 4 violations or violations that pose an imminent risk of harm to the health or safety of the facility residents, the commissioner may immediately temporarily suspend a license, prohibit delivery of services by a facility, or issue a conditional license without meeting the requirements of paragraph (a), clauses (1) to (4). For the purposes of this subdivision, "Level 3" and "Level 4" have the meanings given in section 144G.31. Subd. 14. Request for hearing. A request for hearing must be in writing and must: (1) be mailed or delivered to the commissioner; (2) contain a brief and plain statement describing every matter or issue contested; and (3) contain a brief and plain statement of any new matter that the applicant or assisted living facility believes constitutes a defense or mitigating factor. Subd. 15. Plan required. (a) The process of suspending, revoking, or refusing to renew a license must include a plan for transferring affected residents' cares to other providers by the facility. The commissioner
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shall monitor the transfer plan. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension, the licensee shall provide the commissioner, the lead agencies as defined in section 256B.0911, county adult protection and case managers, and the ombudsman for long-term care with the following information: (1) a list of all residents, including full names and all contact information on file; (2) a list of the resident's legal representatives and designated representatives and family or other contacts listed in the assisted living contract, including full names and all contact information on file; (3) the location or current residence of each resident; (4) the payor sources for each resident, including payor source identification numbers; and (5) for each resident, a copy of the resident's service plan and a list of the types of services being provided. (b) The revocation, refusal to renew, or suspension notification requirement is satisfied by mailing the notice to the address in the license record. The licensee shall cooperate with the commissioner and the lead agencies, county adult protection and case managers, and the ombudsman for long-term care during the process of transferring care of residents to qualified providers. Within three calendar days of being notified of the final revocation, refusal to renew, or suspension action, the facility must notify and disclose to each of the residents, or the resident's legal and designated representatives or emergency contact persons, that the commissioner is taking action against the facility's license by providing a copy of the revocation, refusal to renew, or suspension notice issued by the commissioner. If the facility does not comply with the disclosure requirements in this section, the commissioner shall notify the residents, legal and designated representatives, or emergency contact persons about the actions being taken. Lead agencies, county adult protection and case managers, and the Office of Ombudsman for Long-Term Care may also provide this information. The revocation, refusal to renew, or suspension notice is public data except for any private data contained therein. (c) A facility subject to this subdivision may continue operating while residents are being transferred to other service providers. Subd. 16. Hearing. Within 15 business days of receipt of the licensee's timely appeal of a sanction under this section, other than for a temporary suspension, the commissioner shall request assignment of an administrative law judge. The commissioner's request must include a proposed date, time, and place of hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 90 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause or for purposes of discussing settlement. In no case shall one or more extensions be granted for a total of more than 90 calendar days unless there is a criminal action pending against the licensee. If, while a licensee continues to operate pending an appeal of an order for revocation, suspension, or refusal to renew a license, the commissioner identifies one or more new violations of law that meet the requirements of Level 3 or Level 4 violations as defined in section 144G.31, the commissioner shall act immediately to temporarily suspend the license. Subd. 17. Expedited hearing. (a) Within five business days of receipt of the licensee's timely appeal of a temporary suspension or issuance of a conditional license, the commissioner shall request assignment of an administrative law judge. The request must include a proposed date, time, and place of a hearing. A hearing must be conducted by an administrative law judge pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612, within 30 calendar days of the request for assignment, unless an extension is requested by either party and granted by the administrative law judge for good cause. The commissioner shall issue a notice of hearing by certified mail or personal service at least ten business days before the hearing. Certified
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mail to the last known address is sufficient. The scope of the hearing shall be limited solely to the issue of whether the temporary suspension or issuance of a conditional license should remain in effect and whether there is sufficient evidence to conclude that the licensee's actions or failure to comply with applicable laws are Level 3 or Level 4 violations as defined in section 144G.31, or that there were violations that posed an imminent risk of harm to the resident's health and safety. (b) The administrative law judge shall issue findings of fact, conclusions, and a recommendation within ten business days from the date of hearing. The parties shall have ten calendar days to submit exceptions to the administrative law judge's report. The record shall close at the end of the ten-day period for submission of exceptions. The commissioner's final order shall be issued within ten business days from the close of the record. When an appeal of a temporary immediate suspension or conditional license is withdrawn or dismissed, the commissioner shall issue a final order affirming the temporary immediate suspension or conditional license within ten calendar days of the commissioner's receipt of the withdrawal or dismissal. The licensee is prohibited from operation during the temporary suspension period. (c) When the final order under paragraph (b) affirms an immediate suspension, and a final licensing sanction is issued under subdivisions 1 and 2 and the licensee appeals that sanction, the licensee is prohibited from operation pending a final commissioner's order after the contested case hearing conducted under chapter 14. (d) A licensee whose license is temporarily suspended must comply with the requirements for notification and transfer of residents under subdivision 15. These requirements remain if an appeal is requested. Subd. 18. Time limits for appeals. To appeal the assessment of civil penalties under section 144G.31, and an action against a license under this section, a licensee must request a hearing no later than 15 business days after the licensee receives notice of the action. Subd. 19. Relicensing. If a facility license is revoked, a new application for license may be considered by the commissioner when the conditions upon which the revocation was based have been corrected and satisfactory evidence of this fact has been furnished to the commissioner. A new license may be granted after an inspection has been made and the facility has complied with all provisions of this chapter and adopted rules. Subd. 20. Informal conference. At any time, the commissioner and the applicant, licensee, manager if applicable, or facility may hold an informal conference to exchange information, clarify issues, or resolve issues. Subd. 21. Injunctive relief. In addition to any other remedy provided by law, the commissioner may bring an action in district court to enjoin a person who is involved in the management, operation, or control of a facility or an employee of the facility from illegally engaging in activities regulated by this chapter. The commissioner may bring an action under this subdivision in the district court in Ramsey County or in the district in which the facility is located. The court may grant a temporary restraining order in the proceeding if continued activity by the person who is involved in the management, operation, or control of a facility, or by an employee of the facility, would create an imminent risk of harm to a resident. Subd. 22. Subpoena. In matters pending before the commissioner under this chapter, the commissioner may issue subpoenas and compel the attendance of witnesses and the production of all necessary papers, books, records, documents, and other evidentiary material. If a person fails or refuses to comply with a subpoena or order of the commissioner to appear or testify regarding any matter about which the person may be lawfully questioned or to produce any papers, books, records, documents, or evidentiary materials in the matter to be heard, the commissioner may apply to the district court in any district, and the court shall
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order the person to comply with the commissioner's order or subpoena. The commissioner may administer oaths to witnesses or take their affirmation. Depositions may be taken in or outside the state in the manner provided by law for taking depositions in civil actions. A subpoena or other process or paper may be served on a named person anywhere in the state by an officer authorized to serve subpoenas in civil actions, with the same fees and mileage and in the same manner as prescribed by law for a process issued out of a district court. A person subpoenaed under this subdivision shall receive the same fees, mileage, and other costs that are paid in proceedings in district court. History: 2019 c 60 art 1 s 24,38,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 24 and 38, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 24 and 38, the effective dates. SURVEYS, CORRECTION ORDERS, AND FINES 144G.30 SURVEYS AND INVESTIGATIONS. Subdivision 1. Regulatory powers. (a) The Department of Health is the exclusive state agency charged with the responsibility and duty of surveying and investigating all assisted living facilities required to be licensed under this chapter. The commissioner of health shall enforce all sections of this chapter and the rules adopted under this chapter. (b) The commissioner, upon request to the facility, must be given access to relevant information, records, incident reports, and other documents in the possession of the facility if the commissioner considers them necessary for the discharge of responsibilities. For purposes of surveys and investigations and securing information to determine compliance with licensure laws and rules, the commissioner need not present a release, waiver, or consent to the individual. The identities of residents must be kept private as defined in section 13.02, subdivision 12. Subd. 2. Surveys. The commissioner shall conduct a survey of each assisted living facility on a frequency of at least once every two years. The commissioner may conduct surveys more frequently than every two years based on the license category, the facility's compliance history, the number of residents served, or other factors as determined by the commissioner deemed necessary to ensure the health, safety, and welfare of residents and compliance with the law. Subd. 3. Scheduling surveys. Surveys and investigations shall be conducted without advance notice to the facilities. Surveyors may contact the facility on the day of a survey to arrange for someone to be available at the survey site. The contact does not constitute advance notice. The surveyor must provide presurvey notification to the Office of Ombudsman for Long-Term Care. Subd. 4. Information provided by facility. (a) The assisted living facility shall provide accurate and truthful information to the department during a survey, investigation, or other licensing activities. (b) Upon request of a surveyor, assisted living facilities shall within a reasonable period of time provide a list of current and past residents and their legal representatives and designated representatives that includes addresses and telephone numbers and any other information requested about the services to residents. Subd. 5. Correction orders. (a) A correction order may be issued whenever the commissioner finds upon survey or during a complaint investigation that a facility, a managerial official, or an employee of the facility is not in compliance with this chapter. The correction order shall cite the specific statute and document areas of noncompliance and the time allowed for correction.
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(b) The commissioner shall mail or e-mail copies of any correction order to the facility within 30 calendar days after the survey exit date. A copy of each correction order and copies of any documentation supplied to the commissioner shall be kept on file by the facility and public documents shall be made available for viewing by any person upon request. Copies may be kept electronically. (c) By the correction order date, the facility must document in the facility's records any action taken to comply with the correction order. The commissioner may request a copy of this documentation and the facility's action to respond to the correction order in future surveys, upon a complaint investigation, and as otherwise needed. Subd. 6. Follow-up surveys. The commissioner may conduct follow-up surveys to determine if the facility has corrected deficient issues and systems identified during a survey or complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint investigations, shall be concluded with an exit conference and written information provided on the process for requesting a reconsideration of the survey results. Subd. 7. Required follow-up surveys. For assisted living facilities that have Level 3 or Level 4 violations under section 144G.31, the commissioner shall conduct a follow-up survey within 90 calendar days of the survey. When conducting a follow-up survey, the surveyor shall focus on whether the previous violations have been corrected and may also address any new violations that are observed while evaluating the corrections that have been made. Subd. 8. Notice of noncompliance. If the commissioner finds that the applicant or a facility has not corrected violations by the date specified in the correction order or conditional license resulting from a survey or complaint investigation, the commissioner shall provide a notice of noncompliance with a correction order by e-mailing the notice of noncompliance to the facility. The noncompliance notice must list the violations not corrected. History: 2019 c 60 art 1 s 35,36,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 35 and 36, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 35 and 36, the effective dates. 144G.31 VIOLATIONS AND FINES. Subdivision 1. Categories of violations. Correction orders for violations are categorized by both level and scope. Subd. 2. Levels of violations. Correction orders for violations are categorized by level as follows: (1) Level 1 is a violation that has no potential to cause more than a minimal impact on the resident and does not affect health or safety; (2) Level 2 is a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety, but was not likely to cause serious injury, impairment, or death; (3) Level 3 is a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death; and (4) Level 4 is a violation that results in serious injury, impairment, or death. Subd. 3. Scope of violations. Levels of violations are categorized by scope as follows:
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(1) isolated, when one or a limited number of residents are affected or one or a limited number of staff are involved or the situation has occurred only occasionally; (2) pattern, when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly but is not found to be pervasive; and (3) widespread, when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the residents. Subd. 4. Fine amounts. (a) Fines and enforcement actions under this subdivision may be assessed based on the level and scope of the violations described in subdivisions 2 and 3 as follows and may be imposed immediately with no opportunity to correct the violation prior to imposition: (1) Level 1, no fines or enforcement; (2) Level 2, a fine of $500 per violation, in addition to any enforcement mechanism authorized in section 144G.20 for widespread violations; (3) Level 3, a fine of $3,000 per violation per incident, in addition to any enforcement mechanism authorized in section 144G.20; (4) Level 4, a fine of $5,000 per incident, in addition to any enforcement mechanism authorized in section 144G.20; and (5) for maltreatment violations for which the licensee was determined to be responsible for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000. A fine of $5,000 may be imposed if the commissioner determines the licensee is responsible for maltreatment consisting of sexual assault, death, or abuse resulting in serious injury. (b) When a fine is assessed against a facility for substantiated maltreatment, the commissioner shall not also impose an immediate fine under this chapter for the same circumstance. Subd. 5. Immediate fine; payment. (a) For every Level 3 or Level 4 violation, the commissioner may issue an immediate fine. The licensee must still correct the violation in the time specified. The issuance of an immediate fine may occur in addition to any enforcement mechanism authorized under section 144G.20. The immediate fine may be appealed as allowed under this chapter. (b) The licensee must pay the fines assessed on or before the payment date specified. If the licensee fails to fully comply with the order, the commissioner may issue a second fine or suspend the license until the licensee complies by paying the fine. A timely appeal shall stay payment of the fine until the commissioner issues a final order. (c) A licensee shall promptly notify the commissioner in writing when a violation specified in the order is corrected. If upon reinspection the commissioner determines that a violation has not been corrected as indicated by the order, the commissioner may issue an additional fine. The commissioner shall notify the licensee by mail to the last known address in the licensing record that a second fine has been assessed. The licensee may appeal the second fine as provided under this subdivision. (d) A facility that has been assessed a fine under this section has a right to a reconsideration or hearing under this chapter and chapter 14.
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Subd. 6. Payment of fines required. When a fine has been assessed, the licensee may not avoid payment by closing, selling, or otherwise transferring the license to a third party. In such an event, the licensee shall be liable for payment of the fine. Subd. 7. Additional penalties. In addition to any fine imposed under this section, the commissioner may assess a penalty amount based on costs related to an investigation that results in a final order assessing a fine or other enforcement action authorized by this chapter. Subd. 8. Deposit of fines. Fines collected under this section shall be deposited in a dedicated special revenue account. On an annual basis, the balance in the special revenue account shall be appropriated to the commissioner for special projects to improve home care in Minnesota as recommended by the advisory council established in section 144A.4799. History: 2019 c 60 art 1 s 36,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 36, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 36, the effective date. 144G.32 RECONSIDERATION OF CORRECTION ORDERS AND FINES. Subdivision 1. Reconsideration process required. The commissioner shall make available to assisted living facilities a correction order reconsideration process. This process may be used to challenge the correction order issued, including the level and scope described in section 144G.31, and any fine assessed. When a licensee requests reconsideration of a correction order, the correction order is not stayed while it is under reconsideration. The commissioner shall post information on its website that the licensee requested reconsideration of the correction order and that the review is pending. Subd. 2. Reconsideration process. An assisted living facility may request from the commissioner, in writing, a correction order reconsideration regarding any correction order issued to the facility. The written request for reconsideration must be received by the commissioner within 15 calendar days of the correction order receipt date. The correction order reconsideration shall not be reviewed by any surveyor, investigator, or supervisor that participated in writing or reviewing the correction order being disputed. The correction order reconsiderations may be conducted in person, by telephone, by another electronic form, or in writing, as determined by the commissioner. The commissioner shall respond in writing to the request from a facility for a correction order reconsideration within 60 days of the date the facility requests a reconsideration. The commissioner's response shall identify the commissioner's decision regarding each citation challenged by the facility. Subd. 3. Findings. The findings of a correction order reconsideration process shall be one or more of the following: (1) supported in full: the correction order is supported in full, with no deletion of findings to the citation; (2) supported in substance: the correction order is supported, but one or more findings are deleted or modified without any change in the citation; (3) correction order cited an incorrect licensing requirement: the correction order is amended by changing the correction order to the appropriate statute or rule; (4) correction order was issued under an incorrect citation: the correction order is amended to be issued under the more appropriate correction order citation; (5) the correction order is rescinded;
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(6) fine is amended: it is determined that the fine assigned to the correction order was applied incorrectly; or (7) the level or scope of the citation is modified based on the reconsideration. Subd. 4. Updating the correction order website. If the correction order findings are changed by the commissioner, the commissioner shall update the correction order website. Subd. 5. Exception; provisional licensees. This section does not apply to provisional licensees. History: 2019 c 60 art 1 s 37,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 37, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 37, the effective date. 144G.33 INNOVATION VARIANCE. Subdivision 1. Definition; granting variances. (a) For purposes of this section, "innovation variance" means a specified alternative to a requirement of this chapter. (b) An innovation variance may be granted to allow an assisted living facility to offer services of a type or in a manner that is innovative, will not impair the services provided, will not adversely affect the health, safety, or welfare of the residents, and is likely to improve the services provided. The innovative variance cannot change any of the resident's rights under the assisted living bill of rights. Subd. 2. Conditions. The commissioner may impose conditions on granting an innovation variance that the commissioner considers necessary. Subd. 3. Duration and renewal. The commissioner may limit the duration of any innovation variance and may renew a limited innovation variance. Subd. 4. Applications; innovation variance. An application for innovation variance from the requirements of this chapter may be made at any time, must be made in writing to the commissioner, and must specify the following: (1) the statute or rule from which the innovation variance is requested; (2) the time period for which the innovation variance is requested; (3) the specific alternative action that the licensee proposes; (4) the reasons for the request; and (5) justification that an innovation variance will not impair the services provided, will not adversely affect the health, safety, or welfare of residents, and is likely to improve the services provided. The commissioner may require additional information from the facility before acting on the request. Subd. 5. Grants and denials. The commissioner shall grant or deny each request for an innovation variance in writing within 45 days of receipt of a complete request. Notice of a denial shall contain the reasons for the denial. The terms of a requested innovation variance may be modified upon agreement between the commissioner and the facility. Subd. 6. Violation of innovation variances. A failure to comply with the terms of an innovation variance shall be deemed to be a violation of this chapter.
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Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or deny renewal of an innovation variance if: (1) it is determined that the innovation variance is adversely affecting the health, safety, or welfare of the residents; (2) the facility has failed to comply with the terms of the innovation variance; (3) the facility notifies the commissioner in writing that it wishes to relinquish the innovation variance and be subject to the statute previously varied; or (4) the revocation or denial is required by a change in law. History: 2019 c 60 art 1 s 39,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 39, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 39, the effective date. OPERATIONS AND PHYSICAL PLANT REQUIREMENTS 144G.40 HOUSING AND SERVICES. Subdivision 1. Responsibility for housing and services. The facility is directly responsible to the resident for all housing and service-related matters provided, irrespective of a management contract. Housing and service-related matters include but are not limited to the handling of complaints, the provision of notices, and the initiation of any adverse action against the resident involving housing or services provided by the facility. Subd. 2. Uniform checklist disclosure of services. (a) All assisted living facilities must provide to prospective residents: (1) a disclosure of the categories of assisted living licenses available and the category of license held by the facility; (2) a written checklist listing all services permitted under the facility's license, identifying all services the facility offers to provide under the assisted living facility contract, and identifying all services allowed under the license that the facility does not provide; and (3) an oral explanation of the services offered under the contract. (b) The requirements of paragraph (a) must be completed prior to the execution of the assisted living contract. (c) The commissioner must, in consultation with all interested stakeholders, design the uniform checklist disclosure form for use as provided under paragraph (a). Subd. 3. Reservation of rights. Nothing in this chapter: (1) requires a resident to utilize any service provided by or through, or made available in, a facility; (2) prevents a facility from requiring, as a condition of the contract, that the resident pay for a package of services even if the resident does not choose to use all or some of the services in the package. For residents who are eligible for home and community-based waiver services under chapter 256S and section 256B.49, payment for services will follow the policies of those programs;
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(3) requires a facility to fundamentally alter the nature of the operations of the facility in order to accommodate a resident's request; or (4) affects the duty of a facility to grant a resident's request for reasonable accommodations. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 13,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 13, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 13, the effective date. 144G.401 PAYMENT FOR SERVICES UNDER DISABILITY WAIVERS. For new assisted living facilities that did not operate as registered housing with services establishments prior to August 1, 2021, home and community-based services under section 256B.49 are not available when the new facility setting is adjoined to, or on the same property as, an institution as defined in Code of Federal Regulations, title 42, section 441.301(c). History: 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, subdivision 9, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.41 MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS. Subdivision 1. Minimum requirements. All assisted living facilities shall: (1) distribute to residents the assisted living bill of rights; (2) provide services in a manner that complies with the Nurse Practice Act in sections 148.171 to 148.285; (3) utilize a person-centered planning and service delivery process; (4) have and maintain a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by the Nurse Practice Act in sections 148.171 to 148.285; (5) provide a means for residents to request assistance for health and safety needs 24 hours per day, seven days per week; (6) allow residents the ability to furnish and decorate the resident's unit within the terms of the assisted living contract; (7) permit residents access to food at any time; (8) allow residents to choose the resident's visitors and times of visits; (9) allow the resident the right to choose a roommate if sharing a unit; (10) notify the resident of the resident's right to have and use a lockable door to the resident's unit. The licensee shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible. An assisted living facility must not lock a resident in the resident's unit; (11) develop and implement a staffing plan for determining its staffing level that:
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(i) includes an evaluation, to be conducted at least twice a year, of the appropriateness of staffing levels in the facility; (ii) ensures sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled needs of each resident as required by the residents' assessments and service plans on a 24-hour per day basis; and (iii) ensures that the facility can respond promptly and effectively to individual resident emergencies and to emergency, life safety, and disaster situations affecting staff or residents in the facility; (12) ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time; (iii) capable of communicating with residents; (iv) capable of providing or summoning the appropriate assistance; and (v) capable of following directions; and (13) offer to provide or make available at least the following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. The following apply: (A) menus must be prepared at least one week in advance, and made available to all residents. The facility must encourage residents' involvement in menu planning. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes; (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and (C) the facility cannot require a resident to include and pay for meals in their contract; (ii) weekly housekeeping; (iii) weekly laundry service; (iv) upon the request of the resident, provide direct or reasonable assistance with arranging for transportation to medical and social services appointments, shopping, and other recreation, and provide the name of or other identifying information about the persons responsible for providing this assistance; (v) upon the request of the resident, provide reasonable assistance with accessing community resources and social services available in the community, and provide the name of or other identifying information about persons responsible for providing this assistance; (vi) provide culturally sensitive programs; and
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(vii) have a daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs, and that creates opportunities for active participation in the community at large. Subd. 2. Policies and procedures. Each assisted living facility must have policies and procedures in place to address the following and keep them current: (1) requirements in section 626.557, reporting of maltreatment of vulnerable adults; (2) conducting and handling background studies on employees; (3) orientation, training, and competency evaluations of staff, and a process for evaluating staff performance; (4) handling complaints regarding staff or services provided by staff; (5) conducting initial evaluations of residents' needs and the providers' ability to provide those services; (6) conducting initial and ongoing resident evaluations and assessments of resident needs, including assessments by a registered nurse or appropriate licensed health professional, and how changes in a resident's condition are identified, managed, and communicated to staff and other health care providers as appropriate; (7) orientation to and implementation of the assisted living bill of rights; (8) infection control practices; (9) reminders for medications, treatments, or exercises, if provided; (10) conducting appropriate screenings, or documentation of prior screenings, to show that staff are free of tuberculosis, consistent with current United States Centers for Disease Control and Prevention standards; (11) ensuring that nurses and licensed health professionals have current and valid licenses to practice; (12) medication and treatment management; (13) delegation of tasks by registered nurses or licensed health professionals; (14) supervision of registered nurses and licensed health professionals; and (15) supervision of unlicensed personnel performing delegated tasks. Subd. 3. Infection control program. All assisted living facilities must establish and maintain an infection control program. Subd. 4. Clinical nurse supervision. All assisted living facilities must have a clinical nurse supervisor who is a registered nurse licensed in Minnesota. Subd. 5. Resident councils. The facility must provide a resident council with space and privacy for meetings, where doing so is reasonably achievable. Staff, visitors, and other guests may attend a resident council meeting only at the council's invitation. The facility must designate a staff person who is approved by the resident council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the resident council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the resident council, take reasonably achievable steps to make residents aware of upcoming meetings in a timely manner.
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Subd. 6. Family councils. The facility must provide a family council with space and privacy for meetings, where doing so is reasonably achievable. The facility must designate a staff person who is approved by the family council to be responsible for providing assistance and responding to written requests that result from meetings. The facility must consider the views of the family council and must respond promptly to the grievances and recommendations of the council, but a facility is not required to implement as recommended every request of the council. The facility shall, with the approval of the family council, take reasonably achievable steps to make residents and family members aware of upcoming meetings in a timely manner. Subd. 7. Resident grievances; reporting maltreatment. All facilities must post in a conspicuous place information about the facilities' grievance procedure, and the name, telephone number, and e-mail contact information for the individuals who are responsible for handling resident grievances. The notice must also have the contact information for the state and applicable regional Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities, and must have information for reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center. Subd. 8. Protecting resident rights. All facilities shall ensure that every resident has access to consumer advocacy or legal services by: (1) providing names and contact information, including telephone numbers and e-mail addresses of at least three organizations that provide advocacy or legal services to residents; (2) providing the name and contact information for the Minnesota Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities, including both the state and regional contact information; (3) assisting residents in obtaining information on whether Medicare or medical assistance under chapter 256B will pay for services; (4) making reasonable accommodations for people who have communication disabilities and those who speak a language other than English; and (5) providing all information and notices in plain language and in terms the residents can understand. History: 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.42 BUSINESS OPERATION. Subdivision 1. Display of license. The original current license must be displayed at the main entrance of each assisted living facility. The facility must provide a copy of the license to any person who requests it. Subd. 2. Quality management. The facility shall engage in quality management appropriate to the size of the facility and relevant to the type of services provided. "Quality management activity" means evaluating the quality of care by periodically reviewing resident services, complaints made, and other issues that have occurred and determining whether changes in services, staffing, or other procedures need to be made in order to ensure safe and competent services to residents. Documentation about quality management activity must be available for two years. Information about quality management must be available to the commissioner at the time of the survey, investigation, or renewal.
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Subd. 3. Facility restrictions. (a) This subdivision does not apply to licensees that are Minnesota counties or other units of government. (b) A facility or staff person may not: (1) accept a power-of-attorney from residents for any purpose, and may not accept appointments as guardians or conservators of residents; or (2) borrow a resident's funds or personal or real property, nor in any way convert a resident's property to the possession of the facility or staff person. (c) A facility may not serve as a resident's legal, designated, or other representative. (d) Nothing in this subdivision precludes a facility or staff person from accepting gifts of minimal value or precludes acceptance of donations or bequests made to a facility that are exempt from section 501(c)(3) of the Internal Revenue Code. Subd. 4. Handling residents' finances and property. (a) A facility may assist residents with household budgeting, including paying bills and purchasing household goods, but may not otherwise manage a resident's property. (b) Where funds are deposited with the facility by the resident, the licensee: (1) retains fiduciary and custodial responsibility for the funds; (2) is directly accountable to the resident for the funds; and (3) must maintain records of and provide a resident with receipts for all transactions and purchases made with the resident's funds. When receipts are not available, the transaction or purchase must be documented. (c) Subject to paragraph (d), if responsibilities for day-to-day management of the resident funds are delegated to the manager, the manager must: (1) provide the licensee with a monthly accounting of the resident funds; and (2) meet all legal requirements related to holding and accounting for resident funds. (d) The facility must ensure any party responsible for holding or managing residents' personal funds is bonded or obtains insurance in sufficient amounts to specifically cover losses of resident funds and provides proof of the bond or insurance. Subd. 5. Final accounting; return of money and property. Within 30 days of the effective date of a facility-initiated or resident-initiated termination of housing or services or the death of the resident, the facility must: (1) provide to the resident, resident's legal representative, and resident's designated representative a final statement of account; (2) provide any refunds due; (3) return any money, property, or valuables held in trust or custody by the facility; and (4) as required under section 504B.178, refund the resident's security deposit unless it is applied to the first month's charges.
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Subd. 6. Compliance with requirements for reporting maltreatment of vulnerable adults; abuse prevention plan. (a) The assisted living facility must comply with the requirements for the reporting of maltreatment of vulnerable adults in section 626.557. The facility must establish and implement a written procedure to ensure that all cases of suspected maltreatment are reported. (b) The facility must develop and implement an individual abuse prevention plan for each vulnerable adult. The plan shall contain an individualized review or assessment of the person's susceptibility to abuse by another individual, including other vulnerable adults; the person's risk of abusing other vulnerable adults; and statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults. For purposes of the abuse prevention plan, abuse includes self-abuse. Subd. 7. Posting information for reporting suspected crime and maltreatment. The facility shall support protection and safety through access to the state's systems for reporting suspected criminal activity and suspected vulnerable adult maltreatment by: (1) posting the 911 emergency number in common areas and near telephones provided by the assisted living facility; (2) posting information and the reporting number for the Minnesota Adult Abuse Reporting Center to report suspected maltreatment of a vulnerable adult under section 626.557; and (3) providing reasonable accommodations with information and notices in plain language. Subd. 8. Employee records. (a) The facility must maintain current records of each paid employee, each regularly scheduled volunteer providing services, and each individual contractor providing services. The records must include the following information: (1) evidence of current professional licensure, registration, or certification if licensure, registration, or certification is required by this chapter or rules; (2) records of orientation, required annual training and infection control training, and competency evaluations; (3) current job description, including qualifications, responsibilities, and identification of staff persons providing supervision; (4) documentation of annual performance reviews that identify areas of improvement needed and training needs; (5) for individuals providing assisted living services, verification that required health screenings under subdivision 9 have taken place and the dates of those screenings; and (6) documentation of the background study as required under section 144.057. (b) Each employee record must be retained for at least three years after a paid employee, volunteer, or contractor ceases to be employed by, provide services at, or be under contract with the facility. If a facility ceases operation, employee records must be maintained for three years after facility operations cease. Subd. 9. Tuberculosis prevention and control. The facility must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in the CDC's Morbidity and Mortality Weekly Report (MMWR). The program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors,
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students, and regularly scheduled volunteers. The commissioner shall provide technical assistance regarding implementation of the guidelines. Subd. 10. Disaster planning and emergency preparedness plan. (a) The facility must meet the following requirements: (1) have a written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency; (2) post an emergency disaster plan prominently; (3) provide building emergency exit diagrams to all residents; (4) post emergency exit diagrams on each floor; and (5) have a written policy and procedure regarding missing tenant residents. (b) The facility must provide emergency and disaster training to all staff during the initial staff orientation and annually thereafter and must make emergency and disaster training annually available to all residents. Staff who have not received emergency and disaster training are allowed to work only when trained staff are also working on site. (c) The facility must meet any additional requirements adopted in rule. History: 2019 c 60 art 1 s 15,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 15, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 15, the effective date. 144G.43 RESIDENT RECORD REQUIREMENTS. Subdivision 1. Resident record. (a) Assisted living facilities must maintain records for each resident for whom it is providing services. Entries in the resident records must be current, legible, permanently recorded, dated, and authenticated with the name and title of the person making the entry. (b) Resident records, whether written or electronic, must be protected against loss, tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable relevant federal and state laws. The facility shall establish and implement written procedures to control use, storage, and security of resident records and establish criteria for release of resident information. (c) The facility may not disclose to any other person any personal, financial, or medical information about the resident, except: (1) as may be required by law; (2) to employees or contractors of the facility, another facility, other health care practitioner or provider, or inpatient facility needing information in order to provide services to the resident, but only the information that is necessary for the provision of services; (3) to persons authorized in writing by the resident, including third-party payers; and (4) to representatives of the commissioner authorized to survey or investigate facilities under this chapter or federal laws.
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Subd. 2. Access to records. The facility must ensure that the appropriate records are readily available to employees and contractors authorized to access the records. Resident records must be maintained in a manner that allows for timely access, printing, or transmission of the records. The records must be made readily available to the commissioner upon request. Subd. 3. Contents of resident record. Contents of a resident record include the following for each resident: (1) identifying information, including the resident's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of the resident's emergency contact, legal representatives, and designated representative; (3) names, addresses, and telephone numbers of the resident's health and medical service providers, if known; (4) health information, including medical history, allergies, and when the provider is managing medications, treatments or therapies that require documentation, and other relevant health records; (5) the resident's advance directives, if any; (6) copies of any health care directives, guardianships, powers of attorney, or conservatorships; (7) the facility's current and previous assessments and service plans; (8) all records of communications pertinent to the resident's services; (9) documentation of significant changes in the resident's status and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (10) documentation of incidents involving the resident and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (11) documentation that services have been provided as identified in the service plan; (12) documentation that the resident has received and reviewed the assisted living bill of rights; (13) documentation of complaints received and any resolution; (14) a discharge summary, including service termination notice and related documentation, when applicable; and (15) other documentation required under this chapter and relevant to the resident's services or status. Subd. 4. Transfer of resident records. With the resident's knowledge and consent, if a resident is relocated to another facility or to a nursing home, or if care is transferred to another service provider, the facility must timely convey to the new facility, nursing home, or provider: (1) the resident's full name, date of birth, and insurance information; (2) the name, telephone number, and address of the resident's designated representatives and legal representatives, if any; (3) the resident's current documented diagnoses that are relevant to the services being provided; (4) the resident's known allergies that are relevant to the services being provided;
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(5) the name and telephone number of the resident's physician, if known, and the current physician orders that are relevant to the services being provided; (6) all medication administration records that are relevant to the services being provided; (7) the most recent resident assessment, if relevant to the services being provided; and (8) copies of health care directives, "do not resuscitate" orders, and any guardianship orders or powers of attorney. Subd. 5. Record retention. Following the resident's discharge or termination of services, an assisted living facility must retain a resident's record for at least five years or as otherwise required by state or federal regulations. Arrangements must be made for secure storage and retrieval of resident records if the facility ceases to operate. History: 2019 c 60 art 1 s 21,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 21, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 21, the effective date. 144G.45 MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS. Subdivision 1. Requirements. The following are required for all assisted living facilities: (1) public utilities must be available, and working or inspected and approved water and septic systems must be in place; (2) the location must be publicly accessible to fire department services and emergency medical services; (3) the location's topography must provide sufficient natural drainage and is not subject to flooding; (4) all-weather roads and walks must be provided within the lot lines to the primary entrance and the service entrance, including employees' and visitors' parking at the site; and (5) the location must include space for outdoor activities for residents. Subd. 2. Fire protection and physical environment. (a) Each assisted living facility must have a comprehensive fire protection system that includes: (1) protection throughout by an approved supervised automatic sprinkler system according to building code requirements established in Minnesota Rules, part 1305.0903, or smoke detectors in each occupied room installed and maintained in accordance with the National Fire Protection Association (NFPA) Standard 72; (2) portable fire extinguishers installed and tested in accordance with the NFPA Standard 10; and (3) the physical environment, including walls, floors, ceiling, all furnishings, grounds, systems, and equipment that is kept in a continuous state of good repair and operation with regard to the health, safety, comfort, and well-being of the residents in accordance with a maintenance and repair program. (b) Fire drills in assisted living facilities shall be conducted in accordance with the residential board and care requirements in the Life Safety Code, except that fire drills in secured dementia care units shall be conducted in accordance with section 144G.81, subdivision 2.
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(c) Existing construction or elements, including assisted living facilities that were registered as housing with services establishments under chapter 144D prior to August 1, 2021, shall be permitted to be continued in use provided such use does not constitute a distinct hazard to life. Any existing elements that an authority having jurisdiction deems a distinct hazard to life must be corrected. The facility must document in the facility's records any actions taken to comply with a correction order, and must submit to the commissioner for review and approval prior to correction. Subd. 3. Local laws apply. Assisted living facilities shall comply with all applicable state and local governing laws, regulations, standards, ordinances, and codes for fire safety, building, and zoning requirements. Subd. 4. Design requirements. (a) All assisted living facilities with six or more residents must meet the provisions relevant to assisted living facilities in the most current edition of the Facility Guidelines Institute "Guidelines for Design and Construction of Residential Health, Care and Support Facilities" and of adopted rules. This minimum design standard must be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. In addition to the guidelines, assisted living facilities shall provide the option of a bath in addition to a shower for all residents. (b) If the commissioner decides to update the edition of the guidelines specified in paragraph (a) for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new edition will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which facilities must comply with the updated edition. The date by which facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 5. Assisted living facilities; Life Safety Code. (a) All assisted living facilities with six or more residents must meet the applicable provisions of the most current edition of the NFPA Standard 101, Life Safety Code, Residential Board and Care Occupancies chapter. The minimum design standard shall be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. (b) If the commissioner decides to update the Life Safety Code for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new Life Safety Code will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which facilities must comply with the updated Life Safety Code. The date by which facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 6. New construction; plans. (a) For all new licensure and construction beginning on or after August 1, 2021, the following must be provided to the commissioner: (1) architectural and engineering plans and specifications for new construction must be prepared and signed by architects and engineers who are registered in Minnesota. Final working drawings and specifications for proposed construction must be submitted to the commissioner for review and approval; (2) final architectural plans and specifications must include elevations and sections through the building showing types of construction, and must indicate dimensions and assignments of rooms and areas, room
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finishes, door types and hardware, elevations and details of nurses' work areas, utility rooms, toilet and bathing areas, and large-scale layouts of dietary and laundry areas. Plans must show the location of fixed equipment and sections and details of elevators, chutes, and other conveying systems. Fire walls and smoke partitions must be indicated. The roof plan must show all mechanical installations. The site plan must indicate the proposed and existing buildings, topography, roadways, walks and utility service lines; and (3) final mechanical and electrical plans and specifications must address the complete layout and type of all installations, systems, and equipment to be provided. Heating plans must include heating elements, piping, thermostatic controls, pumps, tanks, heat exchangers, boilers, breeching, and accessories. Ventilation plans must include room air quantities, ducts, fire and smoke dampers, exhaust fans, humidifiers, and air handling units. Plumbing plans must include the fixtures and equipment fixture schedule; water supply and circulating piping, pumps, tanks, riser diagrams, and building drains; the size, location, and elevation of water and sewer services; and the building fire protection systems. Electrical plans must include fixtures and equipment, receptacles, switches, power outlets, circuits, power and light panels, transformers, and service feeders. Plans must show location of nurse call signals, cable lines, fire alarm stations, and fire detectors and emergency lighting. (b) Unless construction is begun within one year after approval of the final working drawing and specifications, the drawings must be resubmitted for review and approval. (c) The commissioner must be notified within 30 days before completion of construction so that the commissioner can make arrangements for a final inspection by the commissioner. (d) At least one set of complete life safety plans, including changes resulting from remodeling or alterations, must be kept on file in the facility. Subd. 7. Variance or waiver. (a) A facility may request that the commissioner grant a variance or waiver from the provisions of this section or section 144G.81, subdivision 5. A request for a waiver must be submitted to the commissioner in writing. Each request must contain: (1) the specific requirement for which the variance or waiver is requested; (2) the reasons for the request; (3) the alternative measures that will be taken if a variance or waiver is granted; (4) the length of time for which the variance or waiver is requested; and (5) other relevant information deemed necessary by the commissioner to properly evaluate the request for the waiver. (b) The decision to grant or deny a variance or waiver must be based on the commissioner's evaluation of the following criteria: (1) whether the waiver will adversely affect the health, treatment, comfort, safety, or well-being of a resident; (2) whether the alternative measures to be taken, if any, are equivalent to or superior to those permitted under section 144G.81, subdivision 5; and (3) whether compliance with the requirements would impose an undue burden on the facility.
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(c) The commissioner must notify the facility in writing of the decision. If a variance or waiver is granted, the notification must specify the period of time for which the variance or waiver is effective and the alternative measures or conditions, if any, to be met by the facility. (d) Alternative measures or conditions attached to a variance or waiver have the force and effect of this chapter and are subject to the issuance of correction orders and fines in accordance with sections 144G.30, subdivision 7, and 144G.31. The amount of fines for a violation of this subdivision is that specified for the specific requirement for which the variance or waiver was requested. (e) A request for renewal of a variance or waiver must be submitted in writing at least 45 days before its expiration date. Renewal requests must contain the information specified in paragraph (b). A variance or waiver must be renewed by the commissioner if the facility continues to satisfy the criteria in paragraph (a) and demonstrates compliance with the alternative measures or conditions imposed at the time the original variance or waiver was granted. (f) The commissioner must deny, revoke, or refuse to renew a variance or waiver if it is determined that the criteria in paragraph (a) are not met. The facility must be notified in writing of the reasons for the decision and informed of the right to appeal the decision. (g) A facility may contest the denial, revocation, or refusal to renew a variance or waiver by requesting a contested case hearing under chapter 14. The facility must submit, within 15 days of the receipt of the commissioner's decision, a written request for a hearing. The request for hearing must set forth in detail the reasons why the facility contends the decision of the commissioner should be reversed or modified. At the hearing, the facility has the burden of proving by a preponderance of the evidence that the facility satisfied the criteria specified in paragraph (b), except in a proceeding challenging the revocation of a variance or waiver. History: 2019 c 60 art 1 s 25,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 25, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 25, the effective date. CONTRACTS, TERMINATIONS, AND RELOCATIONS 144G.50 ASSISTED LIVING CONTRACT REQUIREMENTS. Subdivision 1. Contract required. (a) An assisted living facility may not offer or provide housing or assisted living services to a resident unless it has executed a written contract with the resident. (b) The contract must contain all the terms concerning the provision of: (1) housing; (2) assisted living services, whether provided directly by the facility or by management agreement or other agreement; and (3) the resident's service plan, if applicable. (c) A facility must: (1) offer to prospective residents and provide to the Office of Ombudsman for Long-Term Care a complete unsigned copy of its contract; and
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(2) give a complete copy of any signed contract and any addendums, and all supporting documents and attachments, to the resident promptly after a contract and any addendum has been signed. (d) A contract under this section is a consumer contract under sections 325G.29 to 325G.37. (e) Before or at the time of execution of the contract, the facility must offer the resident the opportunity to identify a designated representative according to subdivision 3. (f) The resident must agree in writing to any additions or amendments to the contract. Upon agreement between the resident and the facility, a new contract or an addendum to the existing contract must be executed and signed. Subd. 2. Contract information. (a) The contract must include in a conspicuous place and manner on the contract the legal name and the license number of the facility. (b) The contract must include the name, telephone number, and physical mailing address, which may not be a public or private post office box, of: (1) the facility and contracted service provider when applicable; (2) the licensee of the facility; (3) the managing agent of the facility, if applicable; and (4) the authorized agent for the facility. (c) The contract must include: (1) a disclosure of the category of assisted living facility license held by the facility and, if the facility is not an assisted living facility with dementia care, a disclosure that it does not hold an assisted living facility with dementia care license; (2) a description of all the terms and conditions of the contract, including a description of and any limitations to the housing or assisted living services to be provided for the contracted amount; (3) a delineation of the cost and nature of any other services to be provided for an additional fee; (4) a delineation and description of any additional fees the resident may be required to pay if the resident's condition changes during the term of the contract; (5) a delineation of the grounds under which the resident may be discharged, evicted, or transferred or have services terminated; (6) billing and payment procedures and requirements; and (7) disclosure of the facility's ability to provide specialized diets. (d) The contract must include a description of the facility's complaint resolution process available to residents, including the name and contact information of the person representing the facility who is designated to handle and resolve complaints. (e) The contract must include a clear and conspicuous notice of: (1) the right under section 144G.54 to appeal the termination of an assisted living contract;
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(2) the facility's policy regarding transfer of residents within the facility, under what circumstances a transfer may occur, and the circumstances under which resident consent is required for a transfer; (3) contact information for the Office of Ombudsman for Long-Term Care, the Ombudsman for Mental Health and Developmental Disabilities, and the Office of Health Facility Complaints; (4) the resident's right to obtain services from an unaffiliated service provider; (5) a description of the facility's policies related to medical assistance waivers under chapter 256S and section 256B.49 and the housing support program under chapter 256I, including: (i) whether the facility is enrolled with the commissioner of human services to provide customized living services under medical assistance waivers; (ii) whether the facility has an agreement to provide housing support under section 256I.04, subdivision 2, paragraph (b); (iii) whether there is a limit on the number of people residing at the facility who can receive customized living services or participate in the housing support program at any point in time. If so, the limit must be provided; (iv) whether the facility requires a resident to pay privately for a period of time prior to accepting payment under medical assistance waivers or the housing support program, and if so, the length of time that private payment is required; (v) a statement that medical assistance waivers provide payment for services, but do not cover the cost of rent; (vi) a statement that residents may be eligible for assistance with rent through the housing support program; and (vii) a description of the rent requirements for people who are eligible for medical assistance waivers but who are not eligible for assistance through the housing support program; (6) the contact information to obtain long-term care consulting services under section 256B.0911; and (7) the toll-free phone number for the Minnesota Adult Abuse Reporting Center. (f) The contract must include a description of the facility's complaint resolution process available to residents, including the name and contact information of the person representing the facility who is designated to handle and resolve complaints. Subd. 3. Designation of representative. (a) Before or at the time of execution of an assisted living contract, an assisted living facility must offer the resident the opportunity to identify a designated representative in writing in the contract and must provide the following verbatim notice on a document separate from the contract: "RIGHT TO DESIGNATE A REPRESENTATIVE FOR CERTAIN PURPOSES. You have the right to name anyone as your "Designated Representative." A Designated Representative can assist you, receive certain information and notices about you, including some information related to your health care, and advocate on your behalf. A Designated Representative does not take the place of your guardian, conservator, power of attorney ("attorney-in-fact"), or health care power of attorney ("health care agent"), if applicable."
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(b) The contract must contain a page or space for the name and contact information of the designated representative and a box the resident must initial if the resident declines to name a designated representative. Notwithstanding subdivision 1, paragraph (f), the resident has the right at any time to add, remove, or change the name and contact information of the designated representative. Subd. 4. Filing. The contract and related documents must be maintained by the facility in files from the date of execution until five years after the contract is terminated or expires. The contracts and all associated documents must be available for on-site inspection by the commissioner at any time. The documents shall be available for viewing or copies shall be made available to the resident and the legal or designated representative at any time. Subd. 5. Waivers of liability prohibited. The contract must not include a waiver of facility liability for the health and safety or personal property of a resident. The contract must not include any provision that the facility knows or should know to be deceptive, unlawful, or unenforceable under state or federal law, nor include any provision that requires or implies a lesser standard of care or responsibility than is required by law. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 26,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 26, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 26, the effective date. 144G.51 ARBITRATION. (a) An assisted living facility must clearly and conspicuously disclose, in writing in an assisted living contract, any arbitration provision in the contract that precludes, limits, or delays the ability of a resident from taking a civil action. (b) An arbitration requirement must not include a choice of law or choice of venue provision. Assisted living contracts must adhere to Minnesota law and any other applicable federal or local law. History: 2019 c 60 art 1 s 31,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 31, is effective August 1, 2021, for contracts entered into on or after that date. Laws 2019, chapter 60, article 1, section 31, the effective date. 144G.52 ASSISTED LIVING CONTRACT TERMINATIONS. Subdivision 1. Definition. For purposes of sections 144G.52 to 144G.55, "termination" means: (1) a facility-initiated termination of housing provided to the resident under the contract; or (2) a facility-initiated termination or nonrenewal of all assisted living services the resident receives from the facility under the contract. Subd. 2. Prerequisite to termination of a contract. (a) Before issuing a notice of termination of an assisted living contract, a facility must schedule and participate in a meeting with the resident and the resident's legal representative and designated representative. The purposes of the meeting are to: (1) explain in detail the reasons for the proposed termination; and (2) identify and offer reasonable accommodations or modifications, interventions, or alternatives to avoid the termination or enable the resident to remain in the facility, including but not limited to securing
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services from another provider of the resident's choosing that may allow the resident to avoid the termination. A facility is not required to offer accommodations, modifications, interventions, or alternatives that fundamentally alter the nature of the operation of the facility. (b) The meeting must be scheduled to take place at least seven days before a notice of termination is issued. The facility must make reasonable efforts to ensure that the resident, legal representative, and designated representative are able to attend the meeting. (c) The facility must notify the resident that the resident may invite family members, relevant health professionals, a representative of the Office of Ombudsman for Long-Term Care, or other persons of the resident's choosing to participate in the meeting. For residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the facility must notify the resident's case manager of the meeting. (d) In the event of an emergency relocation under subdivision 9, where the facility intends to issue a notice of termination and an in-person meeting is impractical or impossible, the facility may attempt to schedule and participate in a meeting under this subdivision via telephone, video, or other means. Subd. 3. Termination for nonpayment. (a) A facility may initiate a termination of housing because of nonpayment of rent or a termination of services because of nonpayment for services. Upon issuance of a notice of termination for nonpayment, the facility must inform the resident that public benefits may be available and must provide contact information for the Senior LinkAge Line under section 256.975, subdivision 7. (b) An interruption to a resident's public benefits that lasts for no more than 60 days does not constitute nonpayment. Subd. 4. Termination for violation of the assisted living contract. A facility may initiate a termination of the assisted living contract if the resident violates a lawful provision of the contract and the resident does not cure the violation within a reasonable amount of time after the facility provides written notice of the ability to cure to the resident. Written notice of the ability to cure may be provided in person or by first class mail. A facility is not required to provide a resident with written notice of the ability to cure for a violation that threatens the health or safety of the resident or another individual in the facility, or for a violation that constitutes illegal conduct. Subd. 5. Expedited termination. (a) A facility may initiate an expedited termination of housing or services if: (1) the resident has engaged in conduct that substantially interferes with the rights, health, or safety of other residents; (2) the resident has engaged in conduct that substantially and intentionally interferes with the safety or physical health of facility staff; or (3) the resident has committed an act listed in section 504B.171 that substantially interferes with the rights, health, or safety of other residents. (b) A facility may initiate an expedited termination of services if: (1) the resident has engaged in conduct that substantially interferes with the resident's health or safety; (2) the resident's assessed needs exceed the scope of services agreed upon in the assisted living contract and are not included in the services the facility disclosed in the uniform checklist; or
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(3) extraordinary circumstances exist, causing the facility to be unable to provide the resident with the services disclosed in the uniform checklist that are necessary to meet the resident's needs. Subd. 6. Right to use provider of resident's choosing. A facility may not terminate the assisted living contract if the underlying reason for termination may be resolved by the resident obtaining services from another provider of the resident's choosing and the resident obtains those services. Subd. 7. Notice of contract termination required. (a) A facility terminating a contract must issue a written notice of termination according to this section. The facility must also send a copy of the termination notice to the Office of Ombudsman for Long-Term Care and, for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, to the resident's case manager, as soon as practicable after providing notice to the resident. A facility may terminate an assisted living contract only as permitted under subdivisions 3, 4, and 5. (b) A facility terminating a contract under subdivision 3 or 4 must provide a written termination notice at least 30 days before the effective date of the termination to the resident, legal representative, and designated representative. (c) A facility terminating a contract under subdivision 5 must provide a written termination notice at least 15 days before the effective date of the termination to the resident, legal representative, and designated representative. (d) If a resident moves out of a facility or cancels services received from the facility, nothing in this section prohibits a facility from enforcing against the resident any notice periods with which the resident must comply under the assisted living contract. Subd. 8. Content of notice of termination. The notice required under subdivision 7 must contain, at a minimum: (1) the effective date of the termination of the assisted living contract; (2) a detailed explanation of the basis for the termination, including the clinical or other supporting rationale; (3) a detailed explanation of the conditions under which a new or amended contract may be executed; (4) a statement that the resident has the right to appeal the termination by requesting a hearing, and information concerning the time frame within which the request must be submitted and the contact information for the agency to which the request must be submitted; (5) a statement that the facility must participate in a coordinated move to another provider or caregiver, as required under section 144G.55; (6) the name and contact information of the person employed by the facility with whom the resident may discuss the notice of termination; (7) information on how to contact the Office of Ombudsman for Long-Term Care to request an advocate to assist regarding the termination; (8) information on how to contact the Senior LinkAge Line under section 256.975, subdivision 7, and an explanation that the Senior LinkAge Line may provide information about other available housing or service options; and
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(9) if the termination is only for services, a statement that the resident may remain in the facility and may secure any necessary services from another provider of the resident's choosing. Subd. 9. Emergency relocation. (a) A facility may remove a resident from the facility in an emergency if necessary due to a resident's urgent medical needs or an imminent risk the resident poses to the health or safety of another facility resident or facility staff member. An emergency relocation is not a termination. (b) In the event of an emergency relocation, the facility must provide a written notice that contains, at a minimum: (1) the reason for the relocation; (2) the name and contact information for the location to which the resident has been relocated and any new service provider; (3) contact information for the Office of Ombudsman for Long-Term Care; (4) if known and applicable, the approximate date or range of dates within which the resident is expected to return to the facility, or a statement that a return date is not currently known; and (5) a statement that, if the facility refuses to provide housing or services after a relocation, the resident has the right to appeal under section 144G.54. The facility must provide contact information for the agency to which the resident may submit an appeal. (c) The notice required under paragraph (b) must be delivered as soon as practicable to: (1) the resident, legal representative, and designated representative; (2) for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the resident's case manager; and (3) the Office of Ombudsman for Long-Term Care if the resident has been relocated and has not returned to the facility within four days. (d) Following an emergency relocation, a facility's refusal to provide housing or services constitutes a termination and triggers the termination process in this section. Subd. 10. Right to return. If a resident is absent from a facility for any reason, including an emergency relocation, the facility shall not refuse to allow a resident to return if a termination of housing has not been effectuated. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 27,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 27, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 27, the effective date. 144G.53 NONRENEWAL OF HOUSING. (a) If a facility decides to not renew a resident's housing under a contract, the facility must either (1) provide the resident with 60 calendar days' notice of the nonrenewal and assistance with relocation planning, or (2) follow the termination procedure under section 144G.52. (b) The notice must include the reason for the nonrenewal and contact information of the Office of Ombudsman for Long-Term Care.
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(c) A facility must: (1) provide notice of the nonrenewal to the Office of Ombudsman for Long-Term Care; (2) for residents who receive home and community-based waiver services under chapter 256S and section 256B.49, provide notice to the resident's case manager; (3) ensure a coordinated move to a safe location, as defined in section 144G.55, subdivision 2, that is appropriate for the resident; (4) ensure a coordinated move to an appropriate service provider identified by the facility, if services are still needed and desired by the resident; (5) consult and cooperate with the resident, legal representative, designated representative, case manager for a resident who receives home and community-based waiver services under chapter 256S and section 256B.49, relevant health professionals, and any other persons of the resident's choosing to make arrangements to move the resident, including consideration of the resident's goals; and (6) prepare a written plan to prepare for the move. (d) A resident may decline to move to the location the facility identifies or to accept services from a service provider the facility identifies, and may instead choose to move to a location of the resident's choosing or receive services from a service provider of the resident's choosing within the timeline prescribed in the nonrenewal notice. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 28,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 28, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 28, the effective date. 144G.54 APPEALS OF CONTRACT TERMINATIONS. Subdivision 1. Right to appeal. Residents have the right to appeal the termination of an assisted living contract. Subd. 2. Permissible grounds to appeal termination. A resident may appeal a termination initiated under section 144G.52, subdivision 3, 4, or 5, on the ground that: (1) there is a factual dispute as to whether the facility had a permissible basis to initiate the termination; (2) the termination would result in great harm or the potential for great harm to the resident as determined by the totality of the circumstances, except in circumstances where there is a greater risk of harm to other residents or staff at the facility; (3) the resident has cured or demonstrated the ability to cure the reasons for the termination, or has identified a reasonable accommodation or modification, intervention, or alternative to the termination; or (4) the facility has terminated the contract in violation of state or federal law. Subd. 3. Appeals process. (a) The Office of Administrative Hearings must conduct an expedited hearing as soon as practicable under this section, but in no event later than 14 calendar days after the office receives the request, unless the parties agree otherwise or the chief administrative law judge deems the timing to be unreasonable, given the complexity of the issues presented.
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(b) The hearing must be held at the facility where the resident lives, unless holding the hearing at that location is impractical, the parties agree to hold the hearing at a different location, or the chief administrative law judge grants a party's request to appear at another location or by telephone or interactive video. (c) The hearing is not a formal contested case proceeding, except when determined necessary by the chief administrative law judge. (d) Parties may but are not required to be represented by counsel. The appearance of a party without counsel does not constitute the unauthorized practice of law. (e) The hearing shall be limited to the amount of time necessary for the participants to expeditiously present the facts about the proposed termination. The administrative law judge shall issue a recommendation to the commissioner as soon as practicable, but in no event later than ten business days after the hearing. Subd. 4. Burden of proof for appeals of termination. (a) The facility bears the burden of proof to establish by a preponderance of the evidence that the termination was permissible if the appeal is brought on the ground listed in subdivision 2, clause (4). (b) The resident bears the burden of proof to establish by a preponderance of the evidence that the termination was permissible if the appeal is brought on the ground listed in subdivision 2, clause (2) or (3). Subd. 5. Determination; content of order. (a) The resident's termination must be rescinded if the resident prevails in the appeal. (b) The order may contain any conditions that may be placed on the resident's continued residency or receipt of services, including but not limited to changes to the service plan or a required increase in services. Subd. 6. Service provision while appeal pending. A termination of housing or services shall not occur while an appeal is pending. If additional services are needed to meet the health or safety needs of the resident while an appeal is pending, the resident is responsible for contracting for those additional services from the facility or another provider and for ensuring the costs for those additional services are covered. Subd. 7. Application of chapter 504B to appeals of terminations. A resident may not bring an action under chapter 504B to challenge a termination that has occurred and been upheld under this section. History: 2019 c 60 art 1 s 29,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 29, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 29, the effective date. 144G.55 COORDINATED MOVES. Subdivision 1. Duties of facility. (a) If a facility terminates an assisted living contract, reduces services to the extent that a resident needs to move, or conducts a planned closure under section 144G.57, the facility: (1) must ensure, subject to paragraph (c), a coordinated move to a safe location that is appropriate for the resident and that is identified by the facility prior to any hearing under section 144G.54; (2) must ensure a coordinated move of the resident to an appropriate service provider identified by the facility prior to any hearing under section 144G.54, provided services are still needed and desired by the resident; and (3) must consult and cooperate with the resident, legal representative, designated representative, case manager for a resident who receives home and community-based waiver services under chapter 256S and
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section 256B.49, relevant health professionals, and any other persons of the resident's choosing to make arrangements to move the resident, including consideration of the resident's goals. (b) A facility may satisfy the requirements of paragraph (a), clauses (1) and (2), by moving the resident to a different location within the same facility, if appropriate for the resident. (c) A resident may decline to move to the location the facility identifies or to accept services from a service provider the facility identifies, and may choose instead to move to a location of the resident's choosing or receive services from a service provider of the resident's choosing within the timeline prescribed in the termination notice. (d) Sixty days before the facility plans to reduce or eliminate one or more services for a particular resident, the facility must provide written notice of the reduction that includes: (1) a detailed explanation of the reasons for the reduction and the date of the reduction; (2) the contact information for the Office of Ombudsman for Long-Term Care and the name and contact information of the person employed by the facility with whom the resident may discuss the reduction of services; (3) a statement that if the services being reduced are still needed by the resident, the resident may remain in the facility and seek services from another provider; and (4) a statement that if the reduction makes the resident need to move, the facility must participate in a coordinated move of the resident to another provider or caregiver, as required under this section. (e) In the event of an unanticipated reduction in services caused by extraordinary circumstances, the facility must provide the notice required under paragraph (d) as soon as possible. (f) If the facility, a resident, a legal representative, or a designated representative determines that a reduction in services will make a resident need to move to a new location, the facility must ensure a coordinated move in accordance with this section, and must provide notice to the Office of Ombudsman for Long-Term Care. (g) Nothing in this section affects a resident's right to remain in the facility and seek services from another provider. Subd. 2. Safe location. A safe location is not a private home where the occupant is unwilling or unable to care for the resident, a homeless shelter, a hotel, or a motel. A facility may not terminate a resident's housing or services if the resident will, as the result of the termination, become homeless, as that term is defined in section 116L.361, subdivision 5, or if an adequate and safe discharge location or adequate and needed service provider has not been identified. This subdivision does not preclude a resident from declining to move to the location the facility identifies. Subd. 3. Relocation plan required. The facility must prepare a relocation plan to prepare for the move to the new location or service provider. Subd. 4. License restrictions. Unless otherwise ordered by the commissioner, if a facility's license is restricted by the commissioner under section 144G.20 such that a resident must move or obtain a new service provider, the facility must comply with this section.
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Subd. 5. No waiver. The rights established under this section for the benefit of residents do not limit any other rights available under other law. No facility may request or require that any resident waive the resident's rights at any time for any reason, including as a condition of admission to the facility. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 30,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 30, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 30, the effective date. 144G.56 TRANSFER OF RESIDENTS WITHIN FACILITY. Subdivision 1. Definition. For the purposes of this section, "transfer" means a move of a resident within the facility to a different room or other private living unit. Subd. 2. Orderly transfer. A facility must provide for the safe, orderly, coordinated, and appropriate transfer of residents within the facility. Subd. 3. Notice required. (a) A facility must provide at least 30 calendar days' advance written notice to the resident and the resident's legal and designated representative of a facility-initiated transfer. The notice must include: (1) the effective date of the proposed transfer; (2) the proposed transfer location; (3) a statement that the resident may refuse the proposed transfer, and may discuss any consequences of a refusal with staff of the facility; (4) the name and contact information of a person employed by the facility with whom the resident may discuss the notice of transfer; and (5) contact information for the Office of Ombudsman for Long-Term Care. (b) Notwithstanding paragraph (a), a facility may conduct a facility-initiated transfer of a resident with less than 30 days' written notice if the transfer is necessary due to: (1) conditions that render the resident's room or private living unit uninhabitable; (2) the resident's urgent medical needs; or (3) a risk to the health or safety of another resident of the facility. Subd. 4. Consent required. The facility may not transfer a resident without first obtaining the resident's consent to the transfer unless: (1) there are conditions that render the resident's room or private living unit uninhabitable; or (2) there is a change in facility operations as described in subdivision 5. Subd. 5. Changes in facility operations. (a) In situations where there is a curtailment, reduction, or capital improvement within a facility necessitating transfers, the facility must: (1) minimize the number of transfers it initiates to complete the project or change in operations; (2) consider individual resident needs and preferences;
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(3) provide reasonable accommodations for individual resident requests regarding the transfers; and (4) in advance of any notice to any residents, legal representatives, or designated representatives, provide notice to the Office of Ombudsman for Long-Term Care and, when appropriate, the Office of Ombudsman for Mental Health and Developmental Disabilities of the curtailment, reduction, or capital improvement and the corresponding needed transfers. Subd. 6. Evaluation. If a resident consents to a transfer, reasonable modifications must be made to the new room or private living unit that are necessary to accommodate the resident's disabilities. The facility must evaluate the resident's individual needs before deciding whether the room or unit to which the resident will be moved is appropriate to the resident's psychological, cognitive, and health care needs, including the accessibility of the bathroom. Subd. 7. Disclosure. When entering into the assisted living contract, the facility must provide a conspicuous notice of the circumstance under which the facility may require a transfer, including any transfer that may be required if the resident will be receiving housing support under section 256I.06. History: 2019 c 60 art 1 s 14,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 14, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 14, the effective date. 144G.57 PLANNED CLOSURES. Subdivision 1. Closure plan required. In the event that an assisted living facility elects to voluntarily close the facility, the facility must notify the commissioner and the Office of Ombudsman for Long-Term Care in writing by submitting a proposed closure plan. Subd. 2. Content of closure plan. The facility's proposed closure plan must include: (1) the procedures and actions the facility will implement to notify residents of the closure, including a copy of the written notice to be given to residents, designated representatives, legal representatives, and family and other resident contacts; (2) the procedures and actions the facility will implement to ensure all residents receive appropriate termination planning in accordance with section 144G.55, and final accountings and returns under section 144G.42, subdivision 5; (3) assessments of the needs and preferences of individual residents; and (4) procedures and actions the facility will implement to maintain compliance with this chapter until all residents have relocated. Subd. 3. Commissioner's approval required prior to implementation. (a) The plan shall be subject to the commissioner's approval and subdivision 6. The facility shall take no action to close the residence prior to the commissioner's approval of the plan. The commissioner shall approve or otherwise respond to the plan as soon as practicable. (b) The commissioner may require the facility to work with a transitional team comprised of department staff, staff of the Office of Ombudsman for Long-Term Care, and other professionals the commissioner deems necessary to assist in the proper relocation of residents.
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Subd. 4. Termination planning and final accounting requirements. Prior to termination, the facility must follow the termination planning requirements under section 144G.55, and final accounting and return requirements under section 144G.42, subdivision 5, for residents. The facility must implement the plan approved by the commissioner and ensure that arrangements for relocation and continued care that meet each resident's social, emotional, and health needs are effectuated prior to closure. Subd. 5. Notice to residents. After the commissioner has approved the relocation plan and at least 60 calendar days before closing, except as provided under subdivision 6, the facility must notify residents, designated representatives, and legal representatives of the closure, the proposed date of closure, the contact information of the ombudsman for long-term care, and that the facility will follow the termination planning requirements under section 144G.55, and final accounting and return requirements under section 144G.42, subdivision 5. For residents who receive home and community-based waiver services under chapter 256S and section 256B.49, the facility must also provide this information to the resident's case manager. Subd. 6. Emergency closures. (a) In the event the facility must close because the commissioner deems the facility can no longer remain open, the facility must meet all requirements in subdivisions 1 to 5, except for any requirements the commissioner finds would endanger the health and safety of residents. In the event the commissioner determines a closure must occur with less than 60 calendar days' notice, the facility shall provide notice to residents as soon as practicable or as directed by the commissioner. (b) Upon request from the commissioner, the facility must provide the commissioner with any documentation related to the appropriateness of its relocation plan, or to any assertion that the facility lacks the funds to comply with subdivisions 1 to 5, or that remaining open would otherwise endanger the health and safety of residents pursuant to paragraph (a). Subd. 7. Other rights. Nothing in this section affects the rights and remedies available under chapter 504B. Subd. 8. Fine. The commissioner may impose a fine for failure to follow the requirements of this section. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 33,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 33, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 33, the effective date. STAFFING REQUIREMENTS 144G.60 STAFFING REQUIREMENTS. Subdivision 1. Background studies required. (a) Employees, contractors, and regularly scheduled volunteers of the facility are subject to the background study required by section 144.057 and may be disqualified under chapter 245C. Nothing in this subdivision shall be construed to prohibit the facility from requiring self-disclosure of criminal conviction information. (b) Data collected under this subdivision shall be classified as private data on individuals under section 13.02, subdivision 12. (c) Termination of an employee in good faith reliance on information or records obtained under this section regarding a confirmed conviction does not subject the assisted living facility to civil liability or liability for unemployment benefits.
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Subd. 2. Qualifications, training, and competency. All staff persons providing assisted living services must be trained and competent in the provision of services consistent with current practice standards appropriate to the resident's needs, and promote and be trained to support the assisted living bill of rights. Subd. 3. Licensed health professionals and nurses. (a) Licensed health professionals and nurses providing services as employees of a licensed facility must possess a current Minnesota license or registration to practice. (b) Licensed health professionals and registered nurses must be competent in assessing resident needs, planning appropriate services to meet resident needs, implementing services, and supervising staff if assigned. (c) Nothing in this section limits or expands the rights of nurses or licensed health professionals to provide services within the scope of their licenses or registrations, as provided by law. Subd. 4. Unlicensed personnel. (a) Unlicensed personnel providing assisted living services must have: (1) successfully completed a training and competency evaluation appropriate to the services provided by the facility and the topics listed in section 144G.61, subdivision 2, paragraph (a); or (2) demonstrated competency by satisfactorily completing a written or oral test on the tasks the unlicensed personnel will perform and on the topics listed in section 144G.61, subdivision 2, paragraph (a); and successfully demonstrated competency on topics in section 144G.61, subdivision 2, paragraph (a), clauses (5), (7), and (8), by a practical skills test. Unlicensed personnel who only provide assisted living services listed in section 144G.08, subdivision 9, clauses (1) to (5), shall not perform delegated nursing or therapy tasks. (b) Unlicensed personnel performing delegated nursing tasks in an assisted living facility must: (1) have successfully completed training and demonstrated competency by successfully completing a written or oral test of the topics in section 144G.61, subdivision 2, paragraphs (a) and (b), and a practical skills test on tasks listed in section 144G.61, subdivision 2, paragraphs (a), clauses (5) and (7), and (b), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform; (2) satisfy the current requirements of Medicare for training or competency of home health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, section 483 or 484.36; or (3) have, before April 19, 1993, completed a training course for nursing assistants that was approved by the commissioner. (c) Unlicensed personnel performing therapy or treatment tasks delegated or assigned by a licensed health professional must meet the requirements for delegated tasks in section 144G.62, subdivision 2, paragraph (a), and any other training or competency requirements within the licensed health professional's scope of practice relating to delegation or assignment of tasks to unlicensed personnel. Subd. 5. Temporary staff. When a facility contracts with a temporary staffing agency, those individuals must meet the same requirements required by this section for personnel employed by the facility and shall be treated as if they are staff of the facility. History: 2019 c 60 art 1 s 7,16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 7 and 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 7 and 16, the effective dates.
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144G.61 STAFF COMPETENCY EVALUATIONS. Subdivision 1. Instructor and competency evaluation requirements. Instructors and competency evaluators must meet the following requirements: (1) training and competency evaluations of unlicensed personnel who only provide assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), must be conducted by individuals with work experience and training in providing these services; and (2) training and competency evaluations of unlicensed personnel providing assisted living services must be conducted by a registered nurse, or another instructor may provide training in conjunction with the registered nurse. Subd. 2. Training and evaluation of unlicensed personnel. (a) Training and competency evaluations for all unlicensed personnel must include the following: (1) documentation requirements for all services provided; (2) reports of changes in the resident's condition to the supervisor designated by the facility; (3) basic infection control, including blood-borne pathogens; (4) maintenance of a clean and safe environment; (5) appropriate and safe techniques in personal hygiene and grooming, including: (i) hair care and bathing; (ii) care of teeth, gums, and oral prosthetic devices; (iii) care and use of hearing aids; and (iv) dressing and assisting with toileting; (6) training on the prevention of falls; (7) standby assistance techniques and how to perform them; (8) medication, exercise, and treatment reminders; (9) basic nutrition, meal preparation, food safety, and assistance with eating; (10) preparation of modified diets as ordered by a licensed health professional; (11) communication skills that include preserving the dignity of the resident and showing respect for the resident and the resident's preferences, cultural background, and family; (12) awareness of confidentiality and privacy; (13) understanding appropriate boundaries between staff and residents and the resident's family; (14) procedures to use in handling various emergency situations; and (15) awareness of commonly used health technology equipment and assistive devices. (b) In addition to paragraph (a), training and competency evaluation for unlicensed personnel providing assisted living services must include:
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(1) observing, reporting, and documenting resident status; (2) basic knowledge of body functioning and changes in body functioning, injuries, or other observed changes that must be reported to appropriate personnel; (3) reading and recording temperature, pulse, and respirations of the resident; (4) recognizing physical, emotional, cognitive, and developmental needs of the resident; (5) safe transfer techniques and ambulation; (6) range of motioning and positioning; and (7) administering medications or treatments as required. History: 2019 c 60 art 1 s 16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 16, the effective date. 144G.62 DELEGATION AND SUPERVISION. Subdivision 1. Availability of contact person to staff. (a) Assisted living facilities must have a registered nurse available for consultation by staff performing delegated nursing tasks and must have an appropriate licensed health professional available if performing other delegated services such as therapies. (b) The appropriate contact person must be readily available either in person, by telephone, or by other means to the staff at times when the staff is providing services. Subd. 2. Delegation of assisted living services. (a) A registered nurse or licensed health professional may delegate tasks only to staff who are competent and possess the knowledge and skills consistent with the complexity of the tasks and according to the appropriate Minnesota practice act. The assisted living facility must establish and implement a system to communicate up-to-date information to the registered nurse or licensed health professional regarding the current available staff and their competency so the registered nurse or licensed health professional has sufficient information to determine the appropriateness of delegating tasks to meet individual resident needs and preferences. (b) When the registered nurse or licensed health professional delegates tasks to unlicensed personnel, that person must ensure that prior to the delegation the unlicensed personnel is trained in the proper methods to perform the tasks or procedures for each resident and is able to demonstrate the ability to competently follow the procedures and perform the tasks. If an unlicensed personnel has not regularly performed the delegated assisted living task for a period of 24 consecutive months, the unlicensed personnel must demonstrate competency in the task to the registered nurse or appropriate licensed health professional. The registered nurse or licensed health professional must document instructions for the delegated tasks in the resident's record. Subd. 3. Supervision of staff. (a) Staff who only provide assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), must be supervised periodically where the services are being provided to verify that the work is being performed competently and to identify problems and solutions to address issues relating to the staff's ability to provide the services. The supervision of the unlicensed personnel must be done by staff of the facility having the authority, skills, and ability to provide the supervision of unlicensed personnel and who can implement changes as needed, and train staff.
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(b) Supervision includes direct observation of unlicensed personnel while the unlicensed personnel are providing the services and may also include indirect methods of gaining input such as gathering feedback from the resident. Supervisory review of staff must be provided at a frequency based on the staff person's competency and performance. Subd. 4. Supervision of staff providing delegated nursing or therapy tasks. (a) Staff who perform delegated nursing or therapy tasks must be supervised by an appropriate licensed health professional or a registered nurse according to the assisted living facility's policy where the services are being provided to verify that the work is being performed competently and to identify problems and solutions related to the staff person's ability to perform the tasks. Supervision of staff performing medication or treatment administration shall be provided by a registered nurse or appropriate licensed health professional and must include observation of the staff administering the medication or treatment and the interaction with the resident. (b) The direct supervision of staff performing delegated tasks must be provided within 30 calendar days after the date on which the individual begins working for the facility and first performs the delegated tasks for residents and thereafter as needed based on performance. This requirement also applies to staff who have not performed delegated tasks for one year or longer. Subd. 5. Documentation. A facility must retain documentation of supervision activities in the personnel records. History: 2019 c 60 art 1 s 16,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 16, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 16, the effective date. 144G.63 ORIENTATION AND ANNUAL TRAINING REQUIREMENTS. Subdivision 1. Orientation of staff and supervisors. All staff providing and supervising direct services must complete an orientation to assisted living facility licensing requirements and regulations before providing assisted living services to residents. The orientation may be incorporated into the training required under subdivision 5. The orientation need only be completed once for each staff person and is not transferable to another facility. Subd. 2. Content of required orientation. (a) The orientation must contain the following topics: (1) an overview of this chapter; (2) an introduction and review of the facility's policies and procedures related to the provision of assisted living services by the individual staff person; (3) handling of emergencies and use of emergency services; (4) compliance with and reporting of the maltreatment of vulnerable adults under section 626.557 to the Minnesota Adult Abuse Reporting Center (MAARC); (5) the assisted living bill of rights and staff responsibilities related to ensuring the exercise and protection of those rights; (6) the principles of person-centered planning and service delivery and how they apply to direct support services provided by the staff person;
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(7) handling of residents' complaints, reporting of complaints, and where to report complaints, including information on the Office of Health Facility Complaints; (8) consumer advocacy services of the Office of Ombudsman for Long-Term Care, Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care Ombudsman at the Department of Human Services, county-managed care advocates, or other relevant advocacy services; and (9) a review of the types of assisted living services the employee will be providing and the facility's category of licensure. (b) In addition to the topics in paragraph (a), orientation may also contain training on providing services to residents with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and the challenges it poses to communication; (2) health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 3. Orientation to resident. Staff providing assisted living services must be oriented specifically to each individual resident and the services to be provided. This orientation may be provided in person, orally, in writing, or electronically. Subd. 4. Training required relating to dementia. All direct care staff and supervisors providing direct services must demonstrate an understanding of the training specified in section 144G.64. Subd. 5. Required annual training. (a) All staff that perform direct services must complete at least eight hours of annual training for each 12 months of employment. The training may be obtained from the facility or another source and must include topics relevant to the provision of assisted living services. The annual training must include: (1) training on reporting of maltreatment of vulnerable adults under section 626.557; (2) review of the assisted living bill of rights and staff responsibilities related to ensuring the exercise and protection of those rights; (3) review of infection control techniques used in the home and implementation of infection control standards including a review of hand washing techniques; the need for and use of protective gloves, gowns, and masks; appropriate disposal of contaminated materials and equipment, such as dressings, needles, syringes, and razor blades; disinfecting reusable equipment; disinfecting environmental surfaces; and reporting communicable diseases; (4) effective approaches to use to problem solve when working with a resident's challenging behaviors, and how to communicate with residents who have dementia, Alzheimer's disease, or related disorders; (5) review of the facility's policies and procedures relating to the provision of assisted living services and how to implement those policies and procedures; and
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(6) the principles of person-centered planning and service delivery and how they apply to direct support services provided by the staff person. (b) In addition to the topics in paragraph (a), annual training may also contain training on providing services to residents with hearing loss. Any training on hearing loss provided under this subdivision must be high quality and research based, may include online training, and must include training on one or more of the following topics: (1) an explanation of age-related hearing loss and how it manifests itself, its prevalence, and challenges it poses to communication; (2) the health impacts related to untreated age-related hearing loss, such as increased incidence of dementia, falls, hospitalizations, isolation, and depression; or (3) information about strategies and technology that may enhance communication and involvement, including communication strategies, assistive listening devices, hearing aids, visual and tactile alerting devices, communication access in real time, and closed captions. Subd. 6. Implementation. The assisted living facility must implement all orientation and training topics covered in this section. Subd. 7. Verification and documentation of orientation and training. The assisted living facility shall retain evidence in the employee record of each staff person having completed the orientation and training required by this section. History: 2019 c 60 art 1 s 22,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 22, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 22, the effective date. 144G.64 TRAINING IN DEMENTIA CARE REQUIRED. (a) All assisted living facilities must meet the following training requirements: (1) supervisors of direct-care staff must have at least eight hours of initial training on topics specified under paragraph (b) within 120 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; (2) direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (3) for assisted living facilities with dementia care, direct-care employees must have completed at least eight hours of initial training on topics specified under paragraph (b) within 80 working hours of the employment start date. Until this initial training is complete, an employee must not provide direct care unless there is another employee on site who has completed the initial eight hours of training on topics related to dementia care and who can act as a resource and assist if issues arise. A trainer of the requirements under paragraph (b) or a supervisor meeting the requirements in clause (1) must be available for consultation with
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the new employee until the training requirement is complete. Direct-care employees must have at least two hours of training on topics related to dementia for each 12 months of employment thereafter; (4) staff who do not provide direct care, including maintenance, housekeeping, and food service staff, must have at least four hours of initial training on topics specified under paragraph (b) within 160 working hours of the employment start date, and must have at least two hours of training on topics related to dementia care for each 12 months of employment thereafter; and (5) new employees may satisfy the initial training requirements by producing written proof of previously completed required training within the past 18 months. (b) Areas of required training include: (1) an explanation of Alzheimer's disease and other dementias; (2) assistance with activities of daily living; (3) problem solving with challenging behaviors; (4) communication skills; and (5) person-centered planning and service delivery. (c) The facility shall provide to consumers in written or electronic form a description of the training program, the categories of employees trained, the frequency of training, and the basic topics covered. History: 2019 c 60 art 1 s 23,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 23, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 23, the effective date. SERVICES 144G.70 SERVICES. Subdivision 1. Acceptance of residents. An assisted living facility may not accept a person as a resident unless the facility has staff, sufficient in qualifications, competency, and numbers, to adequately provide the services agreed to in the assisted living contract. Subd. 2. Initial reviews, assessments, and monitoring. (a) Residents who are not receiving any services shall not be required to undergo an initial nursing assessment. (b) An assisted living facility shall conduct a nursing assessment by a registered nurse of the physical and cognitive needs of the prospective resident and propose a temporary service plan prior to the date on which a prospective resident executes a contract with a facility or the date on which a prospective resident moves in, whichever is earlier. If necessitated by either the geographic distance between the prospective resident and the facility, or urgent or unexpected circumstances, the assessment may be conducted using telecommunication methods based on practice standards that meet the resident's needs and reflect person-centered planning and care delivery. (c) Resident reassessment and monitoring must be conducted no more than 14 calendar days after initiation of services. Ongoing resident reassessment and monitoring must be conducted as needed based
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on changes in the needs of the resident and cannot exceed 90 calendar days from the last date of the assessment. (d) For residents only receiving assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), the facility shall complete an individualized initial review of the resident's needs and preferences. The initial review must be completed within 30 calendar days of the start of services. Resident monitoring and review must be conducted as needed based on changes in the needs of the resident and cannot exceed 90 calendar days from the date of the last review. (e) A facility must inform the prospective resident of the availability of and contact information for long-term care consultation services under section 256B.0911, prior to the date on which a prospective resident executes a contract with a facility or the date on which a prospective resident moves in, whichever is earlier. Subd. 3. Temporary service plan. When a facility initiates services and the individualized assessment required in subdivision 2 has not been completed, the facility must complete a temporary plan and agreement with the resident for services. A temporary service plan shall not be effective for more than 72 hours. Subd. 4. Service plan, implementation, and revisions to service plan. (a) No later than 14 calendar days after the date that services are first provided, an assisted living facility shall finalize a current written service plan. (b) The service plan and any revisions must include a signature or other authentication by the facility and by the resident documenting agreement on the services to be provided. The service plan must be revised, if needed, based on resident reassessment under subdivision 2. The facility must provide information to the resident about changes to the facility's fee for services and how to contact the Office of Ombudsman for Long-Term Care. (c) The facility must implement and provide all services required by the current service plan. (d) The service plan and the revised service plan must be entered into the resident record, including notice of a change in a resident's fees when applicable. (e) Staff providing services must be informed of the current written service plan. (f) The service plan must include: (1) a description of the services to be provided, the fees for services, and the frequency of each service, according to the resident's current assessment and resident preferences; (2) the identification of staff or categories of staff who will provide the services; (3) the schedule and methods of monitoring assessments of the resident; (4) the schedule and methods of monitoring staff providing services; and (5) a contingency plan that includes: (i) the action to be taken if the scheduled service cannot be provided; (ii) information and a method to contact the facility;
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(iii) the names and contact information of persons the resident wishes to have notified in an emergency or if there is a significant adverse change in the resident's condition, including identification of and information as to who has authority to sign for the resident in an emergency; and (iv) the circumstances in which emergency medical services are not to be summoned consistent with chapters 145B and 145C, and declarations made by the resident under those chapters. Subd. 5. Referrals. If a facility reasonably believes that a resident is in need of another medical or health service, including a licensed health professional, or social service provider, the facility shall: (1) determine the resident's preferences with respect to obtaining the service; and (2) inform the resident of the resources available, if known, to assist the resident in obtaining services. Subd. 6. Medical cannabis. Assisted living facilities may exercise the authority and are subject to the protections in section 152.34. Subd. 7. Request for discontinuation of life-sustaining treatment. (a) If a resident, family member, or other caregiver of the resident requests that an employee or other agent of the facility discontinue a life-sustaining treatment, the employee or agent receiving the request: (1) shall take no action to discontinue the treatment; and (2) shall promptly inform the supervisor or other agent of the facility of the resident's request. (b) Upon being informed of a request for discontinuance of treatment, the facility shall promptly: (1) inform the resident that the request will be made known to the physician or advanced practice registered nurse who ordered the resident's treatment; (2) inform the physician or advanced practice registered nurse of the resident's request; and (3) work with the resident and the resident's physician or advanced practice registered nurse to comply with chapter 145C. (c) This section does not require the facility to discontinue treatment, except as may be required by law or court order. (d) This section does not diminish the rights of residents to control their treatments, refuse services, or terminate their relationships with the facility. (e) This section shall be construed in a manner consistent with chapter 145B or 145C, whichever applies, and declarations made by residents under those chapters. History: 2019 c 60 art 1 s 18,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 18, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 18, the effective date. 144G.71 MEDICATION MANAGEMENT. Subdivision 1. Medication management services. (a) This section applies only to assisted living facilities that provide medication management services.
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(b) An assisted living facility that provides medication management services must develop, implement, and maintain current written medication management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse, licensed health professional, or pharmacist consistent with current practice standards and guidelines. (c) The written policies and procedures must address requesting and receiving prescriptions for medications; preparing and giving medications; verifying that prescription drugs are administered as prescribed; documenting medication management activities; controlling and storing medications; monitoring and evaluating medication use; resolving medication errors; communicating with the prescriber, pharmacist, and resident and legal and designated representatives; disposing of unused medications; and educating residents and legal and designated representatives about medications. When controlled substances are being managed, the policies and procedures must also identify how the provider will ensure security and accountability for the overall management, control, and disposition of those substances in compliance with state and federal regulations and with subdivision 23. Subd. 2. Provision of medication management services. (a) For each resident who requests medication management services, the facility shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber under section 151.37 conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must be conducted face-to-face with the resident. The assessment must include an identification and review of all medications the resident is known to be taking. The review and identification must include indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues. (b) The assessment must identify interventions needed in management of medications to prevent diversion of medication by the resident or others who may have access to the medications and provide instructions to the resident and legal or designated representatives on interventions to manage the resident's medications and prevent diversion of medications. For purposes of this section, "diversion of medication" means misuse, theft, or illegal or improper disposition of medications. Subd. 3. Individualized medication monitoring and reassessment. The assisted living facility must monitor and reassess the resident's medication management services as needed under subdivision 2 when the resident presents with symptoms or other issues that may be medication-related and, at a minimum, annually. Subd. 4. Resident refusal. The assisted living facility must document in the resident's record any refusal for an assessment for medication management by the resident. The facility must discuss with the resident the possible consequences of the resident's refusal and document the discussion in the resident's record. Subd. 5. Individualized medication management plan. (a) For each resident receiving medication management services, the assisted living facility must prepare and include in the service plan a written statement of the medication management services that will be provided to the resident. The facility must develop and maintain a current individualized medication management record for each resident based on the resident's assessment that must contain the following: (1) a statement describing the medication management services that will be provided; (2) a description of storage of medications based on the resident's needs and preferences, risk of diversion, and consistent with the manufacturer's directions; (3) documentation of specific resident instructions relating to the administration of medications;
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(4) identification of persons responsible for monitoring medication supplies and ensuring that medication refills are ordered on a timely basis; (5) identification of medication management tasks that may be delegated to unlicensed personnel; (6) procedures for staff notifying a registered nurse or appropriate licensed health professional when a problem arises with medication management services; and (7) any resident-specific requirements relating to documenting medication administration, verifications that all medications are administered as prescribed, and monitoring of medication use to prevent possible complications or adverse reactions. (b) The medication management record must be current and updated when there are any changes. (c) Medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management. Subd. 6. Administration of medication. Medications may be administered by a nurse, physician, or other licensed health practitioner authorized to administer medications or by unlicensed personnel who have been delegated medication administration tasks by a registered nurse. Subd. 7. Delegation of medication administration. When administration of medications is delegated to unlicensed personnel, the assisted living facility must ensure that the registered nurse has: (1) instructed the unlicensed personnel in the proper methods to administer the medications, and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each resident and documented those instructions in the resident's records; and (3) communicated with the unlicensed personnel about the individual needs of the resident. Subd. 8. Documentation of administration of medications. Each medication administered by the assisted living facility staff must be documented in the resident's record. The documentation must include the signature and title of the person who administered the medication. The documentation must include the medication name, dosage, date and time administered, and method and route of administration. The staff must document the reason why medication administration was not completed as prescribed and document any follow-up procedures that were provided to meet the resident's needs when medication was not administered as prescribed and in compliance with the resident's medication management plan. Subd. 9. Documentation of medication setup. Documentation of dates of medication setup, name of medication, quantity of dose, times to be administered, route of administration, and name of person completing medication setup must be done at the time of setup. Subd. 10. Medication management for residents who will be away from home. (a) An assisted living facility that is providing medication management services to the resident must develop and implement policies and procedures for giving accurate and current medications to residents for planned or unplanned times away from home according to the resident's individualized medication management plan. The policies and procedures must state that: (1) for planned time away, the medications must be obtained from the pharmacy or set up by the licensed nurse according to appropriate state and federal laws and nursing standards of practice;
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(2) for unplanned time away, when the pharmacy is not able to provide the medications, a licensed nurse or unlicensed personnel shall provide medications in amounts and dosages needed for the length of the anticipated absence, not to exceed seven calendar days; (3) the resident must be provided written information on medications, including any special instructions for administering or handling the medications, including controlled substances; and (4) the medications must be placed in a medication container or containers appropriate to the provider's medication system and must be labeled with the resident's name and the dates and times that the medications are scheduled. (b) For unplanned time away when the licensed nurse is not available, the registered nurse may delegate this task to unlicensed personnel if: (1) the registered nurse has trained the unlicensed staff and determined the unlicensed staff is competent to follow the procedures for giving medications to residents; and (2) the registered nurse has developed written procedures for the unlicensed personnel, including any special instructions or procedures regarding controlled substances that are prescribed for the resident. The procedures must address: (i) the type of container or containers to be used for the medications appropriate to the provider's medication system; (ii) how the container or containers must be labeled; (iii) written information about the medications to be provided; (iv) how the unlicensed staff must document in the resident's record that medications have been provided, including documenting the date the medications were provided and who received the medications, the person who provided the medications to the resident, the number of medications that were provided to the resident, and other required information; (v) how the registered nurse shall be notified that medications have been provided and whether the registered nurse needs to be contacted before the medications are given to the resident or the designated representative; (vi) a review by the registered nurse of the completion of this task to verify that this task was completed accurately by the unlicensed personnel; and (vii) how the unlicensed personnel must document in the resident's record any unused medications that are returned to the facility, including the name of each medication and the doses of each returned medication. Subd. 11. Prescribed and nonprescribed medication. The assisted living facility must determine whether the facility shall require a prescription for all medications the provider manages. The facility must inform the resident whether the facility requires a prescription for all over-the-counter and dietary supplements before the facility agrees to manage those medications. Subd. 12. Medications; over-the-counter drugs; dietary supplements not prescribed. An assisted living facility providing medication management services for over-the-counter drugs or dietary supplements must retain those items in the original labeled container with directions for use prior to setting up for immediate or later administration. The facility must verify that the medications are up to date and stored as appropriate.
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Subd. 13. Prescriptions. There must be a current written or electronically recorded prescription as defined in section 151.01, subdivision 16a, for all prescribed medications that the assisted living facility is managing for the resident. Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least every 12 months or more frequently as indicated by the assessment in subdivision 2. Prescriptions for controlled substances must comply with chapter 152. Subd. 15. Verbal prescription orders. Verbal prescription orders from an authorized prescriber must be received by a nurse or pharmacist. The order must be handled according to Minnesota Rules, part 6800.6200. Subd. 16. Written or electronic prescription. When a written or electronic prescription is received, it must be communicated to the registered nurse in charge and recorded or placed in the resident's record. Subd. 17. Records confidential. A prescription or order received verbally, in writing, or electronically must be kept confidential according to sections 144.291 to 144.298 and 144A.44. Subd. 18. Medications provided by resident or family members. When the assisted living facility is aware of any medications or dietary supplements that are being used by the resident and are not included in the assessment for medication management services, the staff must advise the registered nurse and document that in the resident record. Subd. 19. Storage of medications. An assisted living facility must store all prescription medications in securely locked and substantially constructed compartments according to the manufacturer's directions and permit only authorized personnel to have access. Subd. 20. Prescription drugs. A prescription drug, prior to being set up for immediate or later administration, must be kept in the original container in which it was dispensed by the pharmacy bearing the original prescription label with legible information including the expiration or beyond-use date of a time-dated drug. Subd. 21. Prohibitions. No prescription drug supply for one resident may be used or saved for use by anyone other than the resident. Subd. 22. Disposition of medications. (a) Any current medications being managed by the assisted living facility must be provided to the resident when the resident's service plan ends or medication management services are no longer part of the service plan. Medications for a resident who is deceased or that have been discontinued or have expired may be provided for disposal. (b) The facility shall dispose of any medications remaining with the facility that are discontinued or expired or upon the termination of the service contract or the resident's death according to state and federal regulations for disposition of medications and controlled substances. (c) Upon disposition, the facility must document in the resident's record the disposition of the medication including the medication's name, strength, prescription number as applicable, quantity, to whom the medications were given, date of disposition, and names of staff and other individuals involved in the disposition. Subd. 23. Loss or spillage. (a) Assisted living facilities providing medication management must develop and implement procedures for loss or spillage of all controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must require that when a spillage of a controlled substance occurs, a notation
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must be made in the resident's record explaining the spillage and the actions taken. The notation must be signed by the person responsible for the spillage and include verification that any contaminated substance was disposed of according to state or federal regulations. (b) The procedures must require that the facility providing medication management investigate any known loss or unaccounted for prescription drugs and take appropriate action required under state or federal regulations and document the investigation in required records. History: 2019 c 60 art 1 s 19,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 19, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 19, the effective date. 144G.72 TREATMENT AND THERAPY MANAGEMENT SERVICES. Subdivision 1. Treatment and therapy management services. This section applies only to assisted living facilities that provide treatment and therapy management services. Subd. 2. Policies and procedures. (a) An assisted living facility that provides treatment and therapy management services must develop, implement, and maintain up-to-date written treatment or therapy management policies and procedures. The policies and procedures must be developed under the supervision and direction of a registered nurse or appropriate licensed health professional consistent with current practice standards and guidelines. (b) The written policies and procedures must address requesting and receiving orders or prescriptions for treatments or therapies, providing the treatment or therapy, documenting treatment or therapy activities, educating and communicating with residents about treatments or therapies they are receiving, monitoring and evaluating the treatment or therapy, and communicating with the prescriber. Subd. 3. Individualized treatment or therapy management plan. For each resident receiving management of ordered or prescribed treatments or therapy services, the assisted living facility must prepare and include in the service plan a written statement of the treatment or therapy services that will be provided to the resident. The facility must also develop and maintain a current individualized treatment and therapy management record for each resident which must contain at least the following: (1) a statement of the type of services that will be provided; (2) documentation of specific resident instructions relating to the treatments or therapy administration; (3) identification of treatment or therapy tasks that will be delegated to unlicensed personnel; (4) procedures for notifying a registered nurse or appropriate licensed health professional when a problem arises with treatments or therapy services; and (5) any resident-specific requirements relating to documentation of treatment and therapy received, verification that all treatment and therapy was administered as prescribed, and monitoring of treatment or therapy to prevent possible complications or adverse reactions. The treatment or therapy management record must be current and updated when there are any changes. Subd. 4. Administration of treatments and therapy. Ordered or prescribed treatments or therapies must be administered by a nurse, physician, or other licensed health professional authorized to perform the treatment or therapy, or may be delegated or assigned to unlicensed personnel by the licensed health professional according to the appropriate practice standards for delegation or assignment. When administration
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of a treatment or therapy is delegated or assigned to unlicensed personnel, the facility must ensure that the registered nurse or authorized licensed health professional has: (1) instructed the unlicensed personnel in the proper methods with respect to each resident and the unlicensed personnel has demonstrated the ability to competently follow the procedures; (2) specified, in writing, specific instructions for each resident and documented those instructions in the resident's record; and (3) communicated with the unlicensed personnel about the individual needs of the resident. Subd. 5. Documentation of administration of treatments and therapies. Each treatment or therapy administered by an assisted living facility must be in the resident record. The documentation must include the signature and title of the person who administered the treatment or therapy and must include the date and time of administration. When treatment or therapies are not administered as ordered or prescribed, the provider must document the reason why it was not administered and any follow-up procedures that were provided to meet the resident's needs. Subd. 6. Treatment and therapy orders. There must be an up-to-date written or electronically recorded order from an authorized prescriber for all treatments and therapies. The order must contain the name of the resident, a description of the treatment or therapy to be provided, and the frequency, duration, and other information needed to administer the treatment or therapy. Treatment and therapy orders must be renewed at least every 12 months. Subd. 7. Right to outside service provider; other payors. Under section 144G.91, a resident is free to retain therapy and treatment services from an off-site service provider. Assisted living facilities must make every effort to assist residents in obtaining information regarding whether the Medicare program, the medical assistance program under chapter 256B, or another public program will pay for any or all of the services. History: 2019 c 60 art 1 s 20,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 20, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 20, the effective date. ASSISTED LIVING FACILITIES WITH DEMENTIA CARE 144G.80 ADDITIONAL LICENSING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. Applicability. This section applies only to assisted living facilities with dementia care. Subd. 2. Demonstrated capacity. (a) An applicant for licensure as an assisted living facility with dementia care must have the ability to provide services in a manner that is consistent with the requirements in this section. The commissioner shall consider the following criteria, including, but not limited to: (1) the experience of the applicant in managing residents with dementia or previous long-term care experience; and (2) the compliance history of the applicant in the operation of any care facility licensed, certified, or registered under federal or state law.
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(b) If the applicant does not have experience in managing residents with dementia, the applicant must employ a consultant for at least the first six months of operation. The consultant must meet the requirements in paragraph (a), clause (1), and make recommendations on providing dementia care services consistent with the requirements of this chapter. The consultant must (1) have two years of work experience related to dementia, health care, gerontology, or a related field, and (2) have completed at least the minimum core training requirements in section 144G.64. The applicant must document an acceptable plan to address the consultant's identified concerns and must either implement the recommendations or document in the plan any consultant recommendations that the applicant chooses not to implement. The commissioner must review the applicant's plan upon request. (c) The commissioner shall conduct an on-site inspection prior to the issuance of an assisted living facility with dementia care license to ensure compliance with the physical environment requirements. (d) The label "Assisted Living Facility with Dementia Care" must be identified on the license. Subd. 3. Relinquishing license. (a) The licensee must notify the commissioner and the Office of Ombudsman for Long-Term Care in writing at least 60 calendar days prior to the voluntary relinquishment of an assisted living facility with dementia care license. For voluntary relinquishment, the facility must at least: (1) give all residents and their designated and legal representatives 60 calendar days' notice. The notice must include at a minimum: (i) the proposed effective date of the relinquishment; (ii) changes in staffing; (iii) changes in services including the elimination or addition of services; (iv) staff training that shall occur when the relinquishment becomes effective; and (v) contact information for the Office of Ombudsman for Long-Term Care; (2) submit a transitional plan to the commissioner demonstrating how the current residents shall be evaluated and assessed to reside in other housing settings that are not an assisted living facility with dementia care, that are physically unsecured, or that would require move-out or transfer to other settings; (3) change service or care plans as appropriate to address any needs the residents may have with the transition; (4) notify the commissioner when the relinquishment process has been completed; and (5) revise advertising materials and disclosure information to remove any reference that the facility is an assisted living facility with dementia care. (b) Nothing in this section alters obligations under section 144G.57. History: 2019 c 60 art 1 s 47; art 2 s 1 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 1, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 1, the effective date.
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144G.81 ADDITIONAL REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH SECURED DEMENTIA CARE UNITS. Subdivision 1. Fire protection and physical environment. An assisted living facility with dementia care that has a secured dementia care unit must meet the requirements of section 144G.45 and the following additional requirements: (1) a hazard vulnerability assessment or safety risk must be performed on and around the property. The hazards indicated on the assessment must be assessed and mitigated to protect the residents from harm; and (2) the facility shall be protected throughout by an approved supervised automatic sprinkler system by August 1, 2029. Subd. 2. Fire drills. Fire drills in secured dementia care units in assisted living facilities with dementia care shall be conducted in accordance with the NFPA Standard 101, Life Safety Code, Healthcare (limited care) chapter. Subd. 3. Assisted living facilities with dementia care and secured dementia care unit; Life Safety Code. (a) All assisted living facilities with dementia care and a secured dementia care unit must meet the applicable provisions of the most current edition of the NFPA Standard 101, Life Safety Code, Healthcare (limited care) chapter. The minimum design standards shall be met for all new licenses, new construction, modifications, renovations, alterations, changes of use, or additions. (b) If the commissioner decides to update the Life Safety Code for purposes of this subdivision, the commissioner must notify the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care and public safety of the planned update by January 15 of the year in which the new Life Safety Code will become effective. Following notice from the commissioner, the new edition shall become effective for assisted living facilities with dementia care and a secured dementia care unit beginning August 1 of that year, unless provided otherwise in law. The commissioner shall, by publication in the State Register, specify a date by which these facilities must comply with the updated Life Safety Code. The date by which these facilities must comply shall not be sooner than six months after publication of the commissioner's notice in the State Register. Subd. 4. Awake staff requirement. An assisted living facility with dementia care providing services in a secured dementia care unit must have an awake person who is physically present in the secured dementia care unit 24 hours per day, seven days per week, who is responsible for responding to the requests of residents for assistance with health and safety needs, and who meets the requirements of section 144G.41, subdivision 1, clause (12). Subd. 5. Variance or waiver. A facility may request under section 144G.45, subdivision 7, that the commissioner grant a variance or waiver from the provisions of this section, except subdivision 4. History: 2019 c 60 art 1 s 11,25,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, sections 11 and 25, is effective August 1, 2021. Laws 2019, chapter 60, article 1, sections 11 and 25, the effective dates. 144G.82 ADDITIONAL RESPONSIBILITIES OF ADMINISTRATION FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. General. The licensee of an assisted living facility with dementia care is responsible for the care and housing of the persons with dementia and the provision of person-centered care that promotes
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each resident's dignity, independence, and comfort. This includes the supervision, training, and overall conduct of the staff. Subd. 2. Additional requirements. (a) The licensee must follow the assisted living license requirements and the criteria in this section. (b) The assisted living director of an assisted living facility with dementia care must complete and document that at least ten hours of the required annual continuing educational requirements relate to the care of individuals with dementia. The training must include medical management of dementia, creating and maintaining supportive and therapeutic environments for residents with dementia, and transitioning and coordinating services for residents with dementia. Continuing education credits may include college courses, preceptor credits, self-directed activities, course instructor credits, corporate training, in-service training, professional association training, web-based training, correspondence courses, telecourses, seminars, and workshops. Subd. 3. Policies. (a) In addition to the policies and procedures required in the licensing of all facilities, the assisted living facility with dementia care licensee must develop and implement policies and procedures that address the: (1) philosophy of how services are provided based upon the assisted living facility licensee's values, mission, and promotion of person-centered care and how the philosophy shall be implemented; (2) evaluation of behavioral symptoms and design of supports for intervention plans, including nonpharmacological practices that are person-centered and evidence-informed; (3) wandering and egress prevention that provides detailed instructions to staff in the event a resident elopes; (4) medication management, including an assessment of residents for the use and effects of medications, including psychotropic medications; (5) staff training specific to dementia care; (6) description of life enrichment programs and how activities are implemented; (7) description of family support programs and efforts to keep the family engaged; (8) limiting the use of public address and intercom systems for emergencies and evacuation drills only; (9) transportation coordination and assistance to and from outside medical appointments; and (10) safekeeping of residents' possessions. (b) The policies and procedures must be provided to residents and the residents' legal and designated representatives at the time of move-in. History: 2019 c 60 art 1 s 47; art 2 s 2 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 2, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 2, the effective date.
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144G.83 ADDITIONAL TRAINING REQUIREMENTS FOR ASSISTED LIVING FACILITIES WITH DEMENTIA CARE. Subdivision 1. General. (a) An assisted living facility with dementia care must provide residents with dementia-trained staff who have been instructed in the person-centered care approach. All direct care staff assigned to care for residents with dementia must be specially trained to work with residents with Alzheimer's disease and other dementias. (b) Only staff trained as specified in subdivisions 2 and 3 shall be assigned to care for dementia residents. (c) Staffing levels must be sufficient to meet the scheduled and unscheduled needs of residents. Staffing levels during nighttime hours shall be based on the sleep patterns and needs of residents. (d) In an emergency situation when trained staff are not available to provide services, the facility may assign staff who have not completed the required training. The particular emergency situation must be documented and must address: (1) the nature of the emergency; (2) how long the emergency lasted; and (3) the names and positions of staff that provided coverage. Subd. 2. Staffing requirements. (a) The licensee must ensure that staff who provide support to residents with dementia can demonstrate a basic understanding and ability to apply dementia training to the residents' emotional and unique health care needs using person-centered planning delivery. Direct care dementia-trained staff and other staff must be trained on the topics identified during the expedited rulemaking process. These requirements are in addition to the licensing requirements for training. (b) Failure to comply with paragraph (a) or subdivision 1 shall result in a fine under section 144G.31. Subd. 3. Supervising staff training. Persons providing or overseeing staff training must have experience and knowledge in the care of individuals with dementia, including: (1) two years of work experience related to Alzheimer's disease or other dementias, or in health care, gerontology, or another related field; and (2) completion of training equivalent to the requirements in this section and successfully passing a skills competency or knowledge test required by the commissioner. Subd. 4. Preservice and in-service training. Preservice and in-service training may include various methods of instruction, such as classroom style, web-based training, video, or one-to-one training. The licensee must have a method for determining and documenting each staff person's knowledge and understanding of the training provided. All training must be documented. History: 2019 c 60 art 1 s 47; art 2 s 3 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 3, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 3, the effective date. 144G.84 SERVICES FOR RESIDENTS WITH DEMENTIA. (a) In addition to the minimum services required in section 144G.41, an assisted living facility with dementia care must also provide the following services:
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(1) assistance with activities of daily living that address the needs of each resident with dementia due to cognitive or physical limitations. These services must meet or be in addition to the requirements in the licensing rules for the facility. Services must be provided in a person-centered manner that promotes resident choice, dignity, and sustains the resident's abilities; (2) nonpharmacological practices that are person-centered and evidence-informed; (3) services to prepare and educate persons living with dementia and their legal and designated representatives about transitions in care and ensuring complete, timely communication between, across, and within settings; and (4) services that provide residents with choices for meaningful engagement with other facility residents and the broader community. (b) Each resident must be evaluated for activities according to the licensing rules of the facility. In addition, the evaluation must address the following: (1) past and current interests; (2) current abilities and skills; (3) emotional and social needs and patterns; (4) physical abilities and limitations; (5) adaptations necessary for the resident to participate; and (6) identification of activities for behavioral interventions. (c) An individualized activity plan must be developed for each resident based on their activity evaluation. The plan must reflect the resident's activity preferences and needs. (d) A selection of daily structured and non-structured activities must be provided and included on the resident's activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (1) occupation or chore related tasks; (2) scheduled and planned events such as entertainment or outings; (3) spontaneous activities for enjoyment or those that may help defuse a behavior; (4) one-to-one activities that encourage positive relationships between residents and staff such as telling a life story, reminiscing, or playing music; (5) spiritual, creative, and intellectual activities; (6) sensory stimulation activities; (7) physical activities that enhance or maintain a resident's ability to ambulate or move; and (8) outdoor activities. (e) Behavioral symptoms that negatively impact the resident and others in the assisted living facility with dementia care must be evaluated and included on the service or care plan. The staff must initiate and coordinate outside consultation or acute care when indicated.
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(f) Support must be offered to family and other significant relationships on a regularly scheduled basis but not less than quarterly. (g) Access to secured outdoor space and walkways that allow residents to enter and return without staff assistance must be provided. History: 2019 c 60 art 1 s 47; art 2 s 4 NOTE: This section, as added by Laws 2019, chapter 60, article 2, section 4, is effective August 1, 2021. Laws 2019, chapter 60, article 2, section 4, the effective date. RESIDENT RIGHTS AND PROTECTIONS 144G.90 REQUIRED NOTICES. Subdivision 1. Assisted living bill of rights; notification to resident. (a) An assisted living facility must provide the resident a written notice of the rights under section 144G.91 before the initiation of services to that resident. The facility shall make all reasonable efforts to provide notice of the rights to the resident in a language the resident can understand. (b) In addition to the text of the assisted living bill of rights in section 144G.91, the notice shall also contain the following statement describing how to file a complaint or report suspected abuse: "If you want to report suspected abuse, neglect, or financial exploitation, you may contact the Minnesota Adult Abuse Reporting Center (MAARC). If you have a complaint about the facility or person providing your services, you may contact the Office of Health Facility Complaints, Minnesota Department of Health. You may also contact the Office of Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health and Developmental Disabilities." (c) The statement must include contact information for the Minnesota Adult Abuse Reporting Center and the telephone number, website address, e-mail address, mailing address, and street address of the Office of Health Facility Complaints at the Minnesota Department of Health, the Office of Ombudsman for Long-Term Care, and the Office of Ombudsman for Mental Health and Developmental Disabilities. The statement must include the facility's name, address, e-mail, telephone number, and name or title of the person at the facility to whom problems or complaints may be directed. It must also include a statement that the facility will not retaliate because of a complaint. (d) A facility must obtain written acknowledgment from the resident of the resident's receipt of the assisted living bill of rights or shall document why an acknowledgment cannot be obtained. Acknowledgment of receipt shall be retained in the resident's record. Subd. 2. Notices in plain language; language accommodations. A facility must provide all notices in plain language that residents can understand and make reasonable accommodations for residents who have communication disabilities and those whose primary language is a language other than English. Subd. 3. Notice of dementia training. An assisted living facility with dementia care shall make available in written or electronic form, to residents and families or other persons who request it, a description of the training program and related training it provides, including the categories of employees trained, the frequency of training, and the basic topics covered. A hard copy of this notice must be provided upon request.
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Subd. 4. Notice of available assistance. A facility shall provide each resident with identifying and contact information about the persons who can assist with health care or supportive services being provided. A facility shall keep each resident informed of changes in the personnel referenced in this subdivision. Subd. 5. Notice to residents; change in ownership or management. (a) A facility must provide written notice to the resident, legal representative, or designated representative of a change of ownership within seven calendar days after the facility receives a new license. (b) A facility must provide prompt written notice to the resident, legal representative, or designated representative, of any change of legal name, telephone number, and physical mailing address, which may not be a public or private post office box, of: (1) the manager of the facility, if applicable; and (2) the authorized agent. History: 2019 c 60 art 1 s 17,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 17, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 17, the effective date. 144G.91 ASSISTED LIVING BILL OF RIGHTS. Subdivision 1. Applicability. This section applies to residents living in assisted living facilities. Subd. 2. Legislative intent. The rights established under this section for the benefit of residents do not limit any other rights available under law. No facility may request or require that any resident waive any of these rights at any time for any reason, including as a condition of admission to the facility. Subd. 3. Information about rights. Before receiving services, residents have the right to be informed by the facility of the rights granted under this section and the recourse residents have if rights are violated. The information must be in plain language and in terms residents can understand. The facility must make reasonable accommodations for residents who have communication disabilities and those who speak a language other than English. Subd. 4. Appropriate care and services. (a) Residents have the right to care and assisted living services that are appropriate based on the resident's needs and according to an up-to-date service plan subject to accepted health care standards. (b) Residents have the right to receive health care and other assisted living services with continuity from people who are properly trained and competent to perform their duties and in sufficient numbers to adequately provide the services agreed to in the assisted living contract and the service plan. Subd. 5. Refusal of care or services. Residents have the right to refuse care or assisted living services and to be informed by the facility of the medical, health-related, or psychological consequences of refusing care or services. Subd. 6. Participation in care and service planning. Residents have the right to actively participate in the planning, modification, and evaluation of their care and services. This right includes: (1) the opportunity to discuss care, services, treatment, and alternatives with the appropriate caregivers; (2) the right to include the resident's legal and designated representatives and persons of the resident's choosing; and
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(3) the right to be told in advance of, and take an active part in decisions regarding, any recommended changes in the service plan. Subd. 7. Courteous treatment. Residents have the right to be treated with courtesy and respect, and to have the resident's property treated with respect. Subd. 8. Freedom from maltreatment. Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act. Subd. 9. Right to come and go freely. Residents have the right to enter and leave the facility as they choose. This right may be restricted only as allowed by other law and consistent with a resident's service plan. Subd. 10. Individual autonomy. Residents have the right to individual autonomy, initiative, and independence in making life choices, including establishing a daily schedule and choosing with whom to interact. Subd. 11. Right to control resources. Residents have the right to control personal resources. Subd. 12. Visitors and social participation. (a) Residents have the right to meet with or receive visits at any time by the resident's family, guardian, conservator, health care agent, attorney, advocate, or religious or social work counselor, or any person of the resident's choosing. This right may be restricted in certain circumstances if necessary for the resident's health and safety and if documented in the resident's service plan. (b) Residents have the right to engage in community life and in activities of their choice. This includes the right to participate in commercial, religious, social, community, and political activities without interference and at their discretion if the activities do not infringe on the rights of other residents. Subd. 13. Personal and treatment privacy. (a) Residents have the right to consideration of their privacy, individuality, and cultural identity as related to their social, religious, and psychological well-being. Staff must respect the privacy of a resident's space by knocking on the door and seeking consent before entering, except in an emergency or where clearly inadvisable or unless otherwise documented in the resident's service plan. (b) Residents have the right to have and use a lockable door to the resident's unit. The facility shall provide locks on the resident's unit. Only a staff member with a specific need to enter the unit shall have keys. This right may be restricted in certain circumstances if necessary for a resident's health and safety and documented in the resident's service plan. (c) Residents have the right to respect and privacy regarding the resident's service plan. Case discussion, consultation, examination, and treatment are confidential and must be conducted discreetly. Privacy must be respected during toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance. Subd. 14. Communication privacy. (a) Residents have the right to communicate privately with persons of their choice. (b) If an assisted living facility is sending or receiving mail on behalf of residents, the assisted living facility must do so without interference. (c) Residents must be provided access to a telephone to make and receive calls.
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Subd. 15. Confidentiality of records. (a) Residents have the right to have personal, financial, health, and medical information kept private, to approve or refuse release of information to any outside party, and to be advised of the assisted living facility's policies and procedures regarding disclosure of the information. Residents must be notified when personal records are requested by any outside party. (b) Residents have the right to access their own records. Subd. 16. Right to furnish and decorate. Residents have the right to furnish and decorate the resident's unit within the terms of the assisted living contract. Subd. 17. Right to choose roommate. Residents have the right to choose a roommate if sharing a unit. Subd. 18. Right to access food. Residents have the right to access food at any time. This right may be restricted in certain circumstances if necessary for the resident's health and safety and if documented in the resident's service plan. Subd. 19. Access to technology. Residents have the right to access Internet service at their expense. Subd. 20. Grievances and inquiries. Residents have the right to make and receive a timely response to a complaint or inquiry, without limitation. Residents have the right to know and every facility must provide the name and contact information of the person representing the facility who is designated to handle and resolve complaints and inquiries. Subd. 21. Access to counsel and advocacy services. Residents have the right to the immediate access by: (1) the resident's legal counsel; (2) any representative of the protection and advocacy system designated by the state under Code of Federal Regulations, title 45, section 1326.21; or (3) any representative of the Office of Ombudsman for Long-Term Care. Subd. 22. Information about charges. Before services are initiated, residents have the right to be notified: (1) of all charges for housing and assisted living services; (2) of any limits on housing and assisted living services available; (3) if known, whether and what amount of payment may be expected from health insurance, public programs, or other sources; and (4) what charges the resident may be responsible for paying. Subd. 23. Information about individuals providing services. Before receiving services identified in the service plan, residents have the right to be told the type and disciplines of staff who will be providing the services, the frequency of visits proposed to be furnished, and other choices that are available for addressing the resident's needs. Subd. 24. Information about other providers and services. Residents have the right to be informed by the assisted living facility, prior to executing an assisted living contract, that other public and private services may be available and that the resident has the right to purchase, contract for, or obtain services from a provider other than the assisted living facility.
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Subd. 25. Resident councils. Residents have the right to organize and participate in resident councils as described in section 144G.41, subdivision 5. Subd. 26. Family councils. Residents have the right to participate in family councils formed by families or residents as described in section 144G.41, subdivision 6. History: 2019 c 60 art 1 s 12,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 12, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 12, the effective date. 144G.911 RESTRICTIONS UNDER HOME AND COMMUNITY-BASED WAIVERS. The resident's rights in section 144G.91, subdivisions 12, 13, and 18, may be restricted for an individual resident only if determined necessary for health and safety reasons identified by the facility through an initial assessment or reassessment under section 144G.70, subdivision 2, and documented in the written service plan under section 144G.70, subdivision 4. Any restrictions of those rights for people served under chapter 256S and section 256B.49 must be documented by the case manager in the resident's coordinated service and support plan (CSSP), as defined in sections 256B.49, subdivision 15, and 256S.10. Nothing in this section affects other laws applicable to or prohibiting restrictions on the resident's rights in section 144G.91, subdivisions 12, 13, and 18. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 11,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 11, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 11, the effective date. 144G.92 RETALIATION PROHIBITED. Subdivision 1. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person acting on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the director or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law; (6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or
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(9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 2. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; or (7) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices. Subd. 3. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken or threatened by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination. Subd. 4. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 2 within 30 days of an initial action described in subdivision 1, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred. Subd. 5. Other laws. Nothing in this section affects the rights available to a resident under section 626.557. History: 2019 c 60 art 1 s 42,47
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NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 42, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 42, the effective date. 144G.93 CONSUMER ADVOCACY AND LEGAL SERVICES. Upon execution of an assisted living contract, every facility must provide the resident with the names and contact information, including telephone numbers and e-mail addresses, of: (1) nonprofit organizations that provide advocacy or legal services to residents including but not limited to the designated protection and advocacy organization in Minnesota that provides advice and representation to individuals with disabilities; and (2) the Office of Ombudsman for Long-Term Care, including both the state and regional contact information. History: 2019 c 60 art 1 s 43,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 43, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 43, the effective date. 144G.95 OFFICE OF OMBUDSMAN FOR LONG-TERM CARE. Subdivision 1. Immunity from liability. The Office of Ombudsman for Long-Term Care and representatives of the office are immune from liability for conduct described in section 256.9742, subdivision 2. Subd. 2. Data classification. All forms and notices received by the Office of Ombudsman for Long-Term Care under this chapter are classified under section 256.9744. History: 2019 c 60 art 1 s 32,47 NOTE: This section, as added by Laws 2019, chapter 60, article 1, section 32, is effective August 1, 2021. Laws 2019, chapter 60, article 1, section 32, the effective date. 144G.9999 RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT TASK FORCE. Subdivision 1. Establishment. The commissioner shall establish a Resident Quality of Care and Outcomes Improvement Task Force to examine and make recommendations, on an ongoing basis, on how to apply proven safety and quality improvement practices and infrastructure to settings and providers that provide long-term services and supports. Subd. 2. Membership. The task force shall include representation from: (1) nonprofit Minnesota-based organizations dedicated to patient safety or innovation in health care safety and quality; (2) Department of Health staff with expertise in issues related to safety and adverse health events; (3) consumer organizations; (4) direct care providers or their representatives; (5) organizations representing long-term care providers and home care providers in Minnesota; (6) the ombudsman for long-term care or a designee;
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(7) national patient safety experts; and (8) other experts in the safety and quality improvement field. The task force shall have at least one public member who either is or has been a resident in an assisted living setting and one public member who has or had a family member living in an assisted living setting. The membership shall be voluntary except that public members may be reimbursed under section 15.059, subdivision 3. Subd. 3. Recommendations. The task force shall periodically provide recommendations to the commissioner and the legislature on changes needed to promote safety and quality improvement practices in long-term care settings and with long-term care providers. The task force shall meet no fewer than four times per year. The task force shall be established by July 1, 2020. History: 2019 c 60 art 1 s 40,47
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626.557 REPORTING OF MALTREATMENT OF VULNERABLE ADULTS. Subdivision 1. Public policy. The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment; to assist in providing safe environments for vulnerable adults; and to provide safe institutional or residential services, community-based services, or living environments for vulnerable adults who have been maltreated. In addition, it is the policy of this state to require the reporting of suspected maltreatment of vulnerable adults, to provide for the voluntary reporting of maltreatment of vulnerable adults, to require the investigation of the reports, and to provide protective and counseling services in appropriate cases. Subd. 2. [Repealed, 1995 c 229 art 1 s 24] Subd. 3. Timing of report. (a) A mandated reporter who has reason to believe that a vulnerable adult is being or has been maltreated, or who has knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained shall immediately report the information to the common entry point. If an individual is a vulnerable adult solely because the individual is admitted to a facility, a mandated reporter is not required to report suspected maltreatment of the individual that occurred prior to admission, unless: (1) the individual was admitted to the facility from another facility and the reporter has reason to believe the vulnerable adult was maltreated in the previous facility; or (2) the reporter knows or has reason to believe that the individual is a vulnerable adult as defined in section 626.5572, subdivision 21, paragraph (a), clause (4). (b) A person not required to report under the provisions of this section may voluntarily report as described above. (c) Nothing in this section requires a report of known or suspected maltreatment, if the reporter knows or has reason to know that a report has been made to the common entry point. (d) Nothing in this section shall preclude a reporter from also reporting to a law enforcement agency. (e) A mandated reporter who knows or has reason to believe that an error under section 626.5572, subdivision 17, paragraph (c), clause (5), occurred must make a report under this subdivision. If the reporter or a facility, at any time believes that an investigation by a lead investigative agency will determine or should determine that the reported error was not neglect according to the criteria under section 626.5572, subdivision 17, paragraph (c), clause (5), the reporter or facility may provide to the common entry point or directly to the lead investigative agency information explaining how the event meets the criteria under section 626.5572, subdivision 17, paragraph (c), clause (5). The lead investigative agency shall consider this information when making an initial disposition of the report under subdivision 9c. Subd. 3a. Report not required. The following events are not required to be reported under this section: (1) A circumstance where federal law specifically prohibits a person from disclosing patient identifying information in connection with a report of suspected maltreatment, unless the vulnerable adult, or the vulnerable adult's guardian, conservator, or legal representative, has consented to disclosure in a manner which conforms to federal requirements. Facilities whose patients or residents are covered by such a federal law shall seek consent to the disclosure of suspected maltreatment from each patient or resident, or a guardian, conservator, or legal representative, upon the patient's or resident's admission to the facility. Persons who
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are prohibited by federal law from reporting an incident of suspected maltreatment shall immediately seek consent to make a report. (2) Verbal or physical aggression occurring between patients, residents, or clients of a facility, or self-abusive behavior by these persons does not constitute abuse unless the behavior causes serious harm. The operator of the facility or a designee shall record incidents of aggression and self-abusive behavior to facilitate review by licensing agencies and county and local welfare agencies. (3) Accidents as defined in section 626.5572, subdivision 3. (4) Events occurring in a facility that result from an individual's error in the provision of therapeutic conduct to a vulnerable adult, as provided in section 626.5572, subdivision 17, paragraph (c), clause (4). (5) Nothing in this section shall be construed to require a report of financial exploitation, as defined in section 626.5572, subdivision 9, solely on the basis of the transfer of money or property by gift or as compensation for services rendered. Subd. 4. Reporting. (a) Except as provided in paragraph (b), a mandated reporter shall immediately make an oral report to the common entry point. The common entry point may accept electronic reports submitted through a web-based reporting system established by the commissioner. Use of a telecommunications device for the deaf or other similar device shall be considered an oral report. The common entry point may not require written reports. To the extent possible, the report must be of sufficient content to identify the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment, any evidence of previous maltreatment, the name and address of the reporter, the time, date, and location of the incident, and any other information that the reporter believes might be helpful in investigating the suspected maltreatment. A mandated reporter may disclose not public data, as defined in section 13.02, and medical records under sections 144.291 to 144.298, to the extent necessary to comply with this subdivision. (b) A boarding care home that is licensed under sections 144.50 to 144.58 and certified under Title 19 of the Social Security Act, a nursing home that is licensed under section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under Code of Federal Regulations, title 42, section 482.66, may submit a report electronically to the common entry point instead of submitting an oral report. The report may be a duplicate of the initial report the facility submits electronically to the commissioner of health to comply with the reporting requirements under Code of Federal Regulations, title 42, section 483.12. The commissioner of health may modify these reporting requirements to include items required under paragraph (a) that are not currently included in the electronic reporting form. Subd. 4a. Internal reporting of maltreatment. (a) Each facility shall establish and enforce an ongoing written procedure in compliance with applicable licensing rules to ensure that all cases of suspected maltreatment are reported. If a facility has an internal reporting procedure, a mandated reporter may meet the reporting requirements of this section by reporting internally. However, the facility remains responsible for complying with the immediate reporting requirements of this section. (b) A facility with an internal reporting procedure that receives an internal report by a mandated reporter shall give the mandated reporter a written notice stating whether the facility has reported the incident to the common entry point. The written notice must be provided within two working days and in a manner that protects the confidentiality of the reporter.
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(c) The written response to the mandated reporter shall note that if the mandated reporter is not satisfied with the action taken by the facility on whether to report the incident to the common entry point, then the mandated reporter may report externally. (d) A facility may not prohibit a mandated reporter from reporting externally, and a facility is prohibited from retaliating against a mandated reporter who reports an incident to the common entry point in good faith. The written notice by the facility must inform the mandated reporter of this protection from retaliatory measures by the facility against the mandated reporter for reporting externally. Subd. 5. Immunity; protection for reporters. (a) A person who makes a good faith report is immune from any civil or criminal liability that might otherwise result from making the report, or from participating in the investigation, or for failure to comply fully with the reporting obligation under section 609.234 or 626.557, subdivision 7. (b) A person employed by a lead investigative agency or a state licensing agency who is conducting or supervising an investigation or enforcing the law in compliance with this section or any related rule or provision of law is immune from any civil or criminal liability that might otherwise result from the person's actions, if the person is acting in good faith and exercising due care. (c) A person who knows or has reason to know a report has been made to a common entry point and who in good faith participates in an investigation of alleged maltreatment is immune from civil or criminal liability that otherwise might result from making the report, or from failure to comply with the reporting obligation or from participating in the investigation. (d) The identity of any reporter may not be disclosed, except as provided in subdivision 12b. (e) For purposes of this subdivision, "person" includes a natural person or any form of a business or legal entity. Subd. 5a. Financial institution cooperation. Financial institutions shall cooperate with a lead investigative agency, law enforcement, or prosecuting authority that is investigating maltreatment of a vulnerable adult and comply with reasonable requests for the production of financial records as authorized under section 13A.02, subdivision 1. Financial institutions are immune from any civil or criminal liability that might otherwise result from complying with this subdivision. Subd. 6. Falsified reports. A person or facility who intentionally makes a false report under the provisions of this section shall be liable in a civil suit for any actual damages suffered by the reported facility, person or persons and for punitive damages up to $10,000 and attorney fees. Subd. 7. Failure to report. A mandated reporter who negligently or intentionally fails to report is liable for damages caused by the failure. Nothing in this subdivision imposes vicarious liability for the acts or omissions of others. Subd. 8. Evidence not privileged. No evidence regarding the maltreatment of the vulnerable adult shall be excluded in any proceeding arising out of the alleged maltreatment on the grounds of lack of competency under section 595.02. Subd. 9. Common entry point designation. (a) Each county board shall designate a common entry point for reports of suspected maltreatment, for use until the commissioner of human services establishes a common entry point. Two or more county boards may jointly designate a single common entry point. The commissioner of human services shall establish a common entry point effective July 1, 2015. The common entry point is the unit responsible for receiving the report of suspected maltreatment under this section.
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(b) The common entry point must be available 24 hours per day to take calls from reporters of suspected maltreatment. The common entry point shall use a standard intake form that includes: (1) the time and date of the report; (2) the name, address, and telephone number of the person reporting; (3) the time, date, and location of the incident; (4) the names of the persons involved, including but not limited to, perpetrators, alleged victims, and witnesses; (5) whether there was a risk of imminent danger to the alleged victim; (6) a description of the suspected maltreatment; (7) the disability, if any, of the alleged victim; (8) the relationship of the alleged perpetrator to the alleged victim; (9) whether a facility was involved and, if so, which agency licenses the facility; (10) any action taken by the common entry point; (11) whether law enforcement has been notified; (12) whether the reporter wishes to receive notification of the initial and final reports; and (13) if the report is from a facility with an internal reporting procedure, the name, mailing address, and telephone number of the person who initiated the report internally. (c) The common entry point is not required to complete each item on the form prior to dispatching the report to the appropriate lead investigative agency. (d) The common entry point shall immediately report to a law enforcement agency any incident in which there is reason to believe a crime has been committed. (e) If a report is initially made to a law enforcement agency or a lead investigative agency, those agencies shall take the report on the appropriate common entry point intake forms and immediately forward a copy to the common entry point. (f) The common entry point staff must receive training on how to screen and dispatch reports efficiently and in accordance with this section. (g) The commissioner of human services shall maintain a centralized database for the collection of common entry point data, lead investigative agency data including maltreatment report disposition, and appeals data. The common entry point shall have access to the centralized database and must log the reports into the database and immediately identify and locate prior reports of abuse, neglect, or exploitation. (h) When appropriate, the common entry point staff must refer calls that do not allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations that might resolve the reporter's concerns. (i) A common entry point must be operated in a manner that enables the commissioner of human services to:
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(1) track critical steps in the reporting, evaluation, referral, response, disposition, and investigative process to ensure compliance with all requirements for all reports; (2) maintain data to facilitate the production of aggregate statistical reports for monitoring patterns of abuse, neglect, or exploitation; (3) serve as a resource for the evaluation, management, and planning of preventative and remedial services for vulnerable adults who have been subject to abuse, neglect, or exploitation; (4) set standards, priorities, and policies to maximize the efficiency and effectiveness of the common entry point; and (5) track and manage consumer complaints related to the common entry point. (j) The commissioners of human services and health shall collaborate on the creation of a system for referring reports to the lead investigative agencies. This system shall enable the commissioner of human services to track critical steps in the reporting, evaluation, referral, response, disposition, investigation, notification, determination, and appeal processes. Subd. 9a. Evaluation and referral of reports made to common entry point. (a) The common entry point must screen the reports of alleged or suspected maltreatment for immediate risk and make all necessary referrals as follows: (1) if the common entry point determines that there is an immediate need for emergency adult protective services, the common entry point agency shall immediately notify the appropriate county agency; (2) if the report contains suspected criminal activity against a vulnerable adult, the common entry point shall immediately notify the appropriate law enforcement agency; (3) the common entry point shall refer all reports of alleged or suspected maltreatment to the appropriate lead investigative agency as soon as possible, but in any event no longer than two working days; (4) if the report contains information about a suspicious death, the common entry point shall immediately notify the appropriate law enforcement agencies, the local medical examiner, and the ombudsman for mental health and developmental disabilities established under section 245.92. Law enforcement agencies shall coordinate with the local medical examiner and the ombudsman as provided by law; and (5) for reports involving multiple locations or changing circumstances, the common entry point shall determine the county agency responsible for emergency adult protective services and the county responsible as the lead investigative agency, using referral guidelines established by the commissioner. (b) If the lead investigative agency receiving a report believes the report was referred by the common entry point in error, the lead investigative agency shall immediately notify the common entry point of the error, including the basis for the lead investigative agency's belief that the referral was made in error. The common entry point shall review the information submitted by the lead investigative agency and immediately refer the report to the appropriate lead investigative agency. Subd. 9b. Response to reports. Law enforcement is the primary agency to conduct investigations of any incident in which there is reason to believe a crime has been committed. Law enforcement shall initiate a response immediately. If the common entry point notified a county agency for emergency adult protective services, law enforcement shall cooperate with that county agency when both agencies are involved and shall exchange data to the extent authorized in subdivision 12b, paragraph (g). County adult protection shall initiate a response immediately. Each lead investigative agency shall complete the investigative process for
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reports within its jurisdiction. A lead investigative agency, county, adult protective agency, licensed facility, or law enforcement agency shall cooperate with other agencies in the provision of protective services, coordinating its investigations, and assisting another agency within the limits of its resources and expertise and shall exchange data to the extent authorized in subdivision 12b, paragraph (g). The lead investigative agency shall obtain the results of any investigation conducted by law enforcement officials. The lead investigative agency has the right to enter facilities and inspect and copy records as part of investigations. The lead investigative agency has access to not public data, as defined in section 13.02, and medical records under sections 144.291 to 144.298, that are maintained by facilities to the extent necessary to conduct its investigation. Each lead investigative agency shall develop guidelines for prioritizing reports for investigation. Subd. 9c. Lead investigative agency; notifications, dispositions, determinations. (a) Upon request of the reporter, the lead investigative agency shall notify the reporter that it has received the report, and provide information on the initial disposition of the report within five business days of receipt of the report, provided that the notification will not endanger the vulnerable adult or hamper the investigation. (b) Upon conclusion of every investigation it conducts, the lead investigative agency shall make a final disposition as defined in section 626.5572, subdivision 8. (c) When determining whether the facility or individual is the responsible party for substantiated maltreatment or whether both the facility and the individual are responsible for substantiated maltreatment, the lead investigative agency shall consider at least the following mitigating factors: (1) whether the actions of the facility or the individual caregivers were in accordance with, and followed the terms of, an erroneous physician order, prescription, resident care plan, or directive. This is not a mitigating factor when the facility or caregiver is responsible for the issuance of the erroneous order, prescription, plan, or directive or knows or should have known of the errors and took no reasonable measures to correct the defect before administering care; (2) the comparative responsibility between the facility, other caregivers, and requirements placed upon the employee, including but not limited to, the facility's compliance with related regulatory standards and factors such as the adequacy of facility policies and procedures, the adequacy of facility training, the adequacy of an individual's participation in the training, the adequacy of caregiver supervision, the adequacy of facility staffing levels, and a consideration of the scope of the individual employee's authority; and (3) whether the facility or individual followed professional standards in exercising professional judgment. (d) When substantiated maltreatment is determined to have been committed by an individual who is also the facility license holder, both the individual and the facility must be determined responsible for the maltreatment, and both the background study disqualification standards under section 245C.15, subdivision 4, and the licensing actions under section 245A.06 or 245A.07 apply. (e) The lead investigative agency shall complete its final disposition within 60 calendar days. If the lead investigative agency is unable to complete its final disposition within 60 calendar days, the lead investigative agency shall notify the following persons provided that the notification will not endanger the vulnerable adult or hamper the investigation: (1) the vulnerable adult or the vulnerable adult's guardian or health care agent, when known, if the lead investigative agency knows them to be aware of the investigation; and (2) the facility, where applicable. The notice shall contain the reason for the delay and the projected completion date. If the lead investigative agency is unable to complete its final disposition by a subsequent projected completion date, the lead investigative agency shall again notify the vulnerable adult or the vulnerable adult's guardian or health care agent, when known if the lead investigative agency knows them to be aware of the investigation, and the facility, where applicable, of the reason for the delay and the revised projected
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completion date provided that the notification will not endanger the vulnerable adult or hamper the investigation. The lead investigative agency must notify the health care agent of the vulnerable adult only if the health care agent's authority to make health care decisions for the vulnerable adult is currently effective under section 145C.06 and not suspended under section 524.5-310 and the investigation relates to a duty assigned to the health care agent by the principal. A lead investigative agency's inability to complete the final disposition within 60 calendar days or by any projected completion date does not invalidate the final disposition. (f) Within ten calendar days of completing the final disposition, the lead investigative agency shall provide a copy of the public investigation memorandum under subdivision 12b, paragraph (b), clause (1), when required to be completed under this section, to the following persons: (1) the vulnerable adult, or the vulnerable adult's guardian or health care agent, if known, unless the lead investigative agency knows that the notification would endanger the well-being of the vulnerable adult; (2) the reporter, if the reporter requested notification when making the report, provided this notification would not endanger the well-being of the vulnerable adult; (3) the alleged perpetrator, if known; (4) the facility; and (5) the ombudsman for long-term care, or the ombudsman for mental health and developmental disabilities, as appropriate. (g) If, as a result of a reconsideration, review, or hearing, the lead investigative agency changes the final disposition, or if a final disposition is changed on appeal, the lead investigative agency shall notify the parties specified in paragraph (f). (h) The lead investigative agency shall notify the vulnerable adult who is the subject of the report or the vulnerable adult's guardian or health care agent, if known, and any person or facility determined to have maltreated a vulnerable adult, of their appeal or review rights under this section or section 256.021. (i) The lead investigative agency shall routinely provide investigation memoranda for substantiated reports to the appropriate licensing boards. These reports must include the names of substantiated perpetrators. The lead investigative agency may not provide investigative memoranda for inconclusive or false reports to the appropriate licensing boards unless the lead investigative agency's investigation gives reason to believe that there may have been a violation of the applicable professional practice laws. If the investigation memorandum is provided to a licensing board, the subject of the investigation memorandum shall be notified and receive a summary of the investigative findings. (j) In order to avoid duplication, licensing boards shall consider the findings of the lead investigative agency in their investigations if they choose to investigate. This does not preclude licensing boards from considering other information. (k) The lead investigative agency must provide to the commissioner of human services its final dispositions, including the names of all substantiated perpetrators. The commissioner of human services shall establish records to retain the names of substantiated perpetrators. Subd. 9d. Administrative reconsideration; review panel. (a) Except as provided under paragraph (e), any individual or facility which a lead investigative agency determines has maltreated a vulnerable adult, or the vulnerable adult or an interested person acting on behalf of the vulnerable adult, regardless of the lead investigative agency's determination, who contests the lead investigative agency's final disposition of an allegation of maltreatment, may request the lead investigative agency to reconsider its final disposition. The request for reconsideration must be submitted in writing to the lead investigative agency within 15 calendar days after receipt of notice of final disposition or, if the request is made by an interested person who is not entitled to notice, within 15 days after receipt of the notice by the vulnerable adult or the vulnerable adult's guardian or health care agent. If mailed, the request for reconsideration must be postmarked and sent to the
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lead investigative agency within 15 calendar days of the individual's or facility's receipt of the final disposition. If the request for reconsideration is made by personal service, it must be received by the lead investigative agency within 15 calendar days of the individual's or facility's receipt of the final disposition. An individual who was determined to have maltreated a vulnerable adult under this section and who was disqualified on the basis of serious or recurring maltreatment under sections 245C.14 and 245C.15, may request reconsideration of the maltreatment determination and the disqualification. The request for reconsideration of the maltreatment determination and the disqualification must be submitted in writing within 30 calendar days of the individual's receipt of the notice of disqualification under sections 245C.16 and 245C.17. If mailed, the request for reconsideration of the maltreatment determination and the disqualification must be postmarked and sent to the lead investigative agency within 30 calendar days of the individual's receipt of the notice of disqualification. If the request for reconsideration is made by personal service, it must be received by the lead investigative agency within 30 calendar days after the individual's receipt of the notice of disqualification. (b) Except as provided under paragraphs (e) and (f), if the lead investigative agency denies the request or fails to act upon the request within 15 working days after receiving the request for reconsideration, the person or facility entitled to a fair hearing under section 256.045, may submit to the commissioner of human services a written request for a hearing under that statute. The vulnerable adult, or an interested person acting on behalf of the vulnerable adult, may request a review by the Vulnerable Adult Maltreatment Review Panel under section 256.021 if the lead investigative agency denies the request or fails to act upon the request, or if the vulnerable adult or interested person contests a reconsidered disposition. The lead investigative agency shall notify persons who request reconsideration of their rights under this paragraph. The request must be submitted in writing to the review panel and a copy sent to the lead investigative agency within 30 calendar days of receipt of notice of a denial of a request for reconsideration or of a reconsidered disposition. The request must specifically identify the aspects of the lead investigative agency determination with which the person is dissatisfied. (c) If, as a result of a reconsideration or review, the lead investigative agency changes the final disposition, it shall notify the parties specified in subdivision 9c, paragraph (f). (d) For purposes of this subdivision, "interested person acting on behalf of the vulnerable adult" means a person designated in writing by the vulnerable adult to act on behalf of the vulnerable adult, or a legal guardian or conservator or other legal representative, a proxy or health care agent appointed under chapter 145B or 145C, or an individual who is related to the vulnerable adult, as defined in section 245A.02, subdivision 13. (e) If an individual was disqualified under sections 245C.14 and 245C.15, on the basis of a determination of maltreatment, which was serious or recurring, and the individual has requested reconsideration of the maltreatment determination under paragraph (a) and reconsideration of the disqualification under sections 245C.21 to 245C.27, reconsideration of the maltreatment determination and requested reconsideration of the disqualification shall be consolidated into a single reconsideration. If reconsideration of the maltreatment determination is denied and the individual remains disqualified following a reconsideration decision, the individual may request a fair hearing under section 256.045. If an individual requests a fair hearing on the maltreatment determination and the disqualification, the scope of the fair hearing shall include both the maltreatment determination and the disqualification. (f) If a maltreatment determination or a disqualification based on serious or recurring maltreatment is the basis for a denial of a license under section 245A.05 or a licensing sanction under section 245A.07, the license holder has the right to a contested case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. As provided for under section 245A.08, the scope of the contested case hearing must include
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the maltreatment determination, disqualification, and licensing sanction or denial of a license. In such cases, a fair hearing must not be conducted under section 256.045. Except for family child care and child foster care, reconsideration of a maltreatment determination under this subdivision, and reconsideration of a disqualification under section 245C.22, must not be conducted when: (1) a denial of a license under section 245A.05, or a licensing sanction under section 245A.07, is based on a determination that the license holder is responsible for maltreatment or the disqualification of a license holder based on serious or recurring maltreatment; (2) the denial of a license or licensing sanction is issued at the same time as the maltreatment determination or disqualification; and (3) the license holder appeals the maltreatment determination or disqualification, and denial of a license or licensing sanction. Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment determination or disqualification, but does not appeal the denial of a license or a licensing sanction, reconsideration of the maltreatment determination shall be conducted under sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the disqualification shall be conducted under section 245C.22. In such cases, a fair hearing shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d. If the disqualified subject is an individual other than the license holder and upon whom a background study must be conducted under chapter 245C, the hearings of all parties may be consolidated into a single contested case hearing upon consent of all parties and the administrative law judge. (g) Until August 1, 2002, an individual or facility that was determined by the commissioner of human services or the commissioner of health to be responsible for neglect under section 626.5572, subdivision 17, after October 1, 1995, and before August 1, 2001, that believes that the finding of neglect does not meet an amended definition of neglect may request a reconsideration of the determination of neglect. The commissioner of human services or the commissioner of health shall mail a notice to the last known address of individuals who are eligible to seek this reconsideration. The request for reconsideration must state how the established findings no longer meet the elements of the definition of neglect. The commissioner shall review the request for reconsideration and make a determination within 15 calendar days. The commissioner's decision on this reconsideration is the final agency action. (1) For purposes of compliance with the data destruction schedule under subdivision 12b, paragraph (d), when a finding of substantiated maltreatment has been changed as a result of a reconsideration under this paragraph, the date of the original finding of a substantiated maltreatment must be used to calculate the destruction date. (2) For purposes of any background studies under chapter 245C, when a determination of substantiated maltreatment has been changed as a result of a reconsideration under this paragraph, any prior disqualification of the individual under chapter 245C that was based on this determination of maltreatment shall be rescinded, and for future background studies under chapter 245C the commissioner must not use the previous determination of substantiated maltreatment as a basis for disqualification or as a basis for referring the individual's maltreatment history to a health-related licensing board under section 245C.31. Subd. 9e. Education requirements. (a) The commissioners of health, human services, and public safety shall cooperate in the development of a joint program for education of lead investigative agency investigators in the appropriate techniques for investigation of complaints of maltreatment. This program must be developed
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by July 1, 1996. The program must include but need not be limited to the following areas: (1) information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4) conclusions based on evidence; (5) interviewing skills, including specialized training to interview people with unique needs; (6) report writing; (7) coordination and referral to other necessary agencies such as law enforcement and judicial agencies; (8) human relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family systems and the appropriate methods for interviewing relatives in the course of the assessment or investigation; (10) the protective social services that are available to protect alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by which lead investigative agency investigators and law enforcement workers cooperate in conducting assessments and investigations in order to avoid duplication of efforts; and (12) data practices laws and procedures, including provisions for sharing data. (b) The commissioner of human services shall conduct an outreach campaign to promote the common entry point for reporting vulnerable adult maltreatment. This campaign shall use the Internet and other means of communication. (c) The commissioners of health, human services, and public safety shall offer at least annual education to others on the requirements of this section, on how this section is implemented, and investigation techniques. (d) The commissioner of human services, in coordination with the commissioner of public safety shall provide training for the common entry point staff as required in this subdivision and the program courses described in this subdivision, at least four times per year. At a minimum, the training shall be held twice annually in the seven-county metropolitan area and twice annually outside the seven-county metropolitan area. The commissioners shall give priority in the program areas cited in paragraph (a) to persons currently performing assessments and investigations pursuant to this section. (e) The commissioner of public safety shall notify in writing law enforcement personnel of any new requirements under this section. The commissioner of public safety shall conduct regional training for law enforcement personnel regarding their responsibility under this section. (f) Each lead investigative agency investigator must complete the education program specified by this subdivision within the first 12 months of work as a lead investigative agency investigator. A lead investigative agency investigator employed when these requirements take effect must complete the program within the first year after training is available or as soon as training is available. All lead investigative agency investigators having responsibility for investigation duties under this section must receive a minimum of eight hours of continuing education or in-service training each year specific to their duties under this section. Subd. 10. Duties of county social service agency. (a) When the common entry point refers a report to the county social service agency as the lead investigative agency or makes a referral to the county social service agency for emergency adult protective services, or when another lead investigative agency requests assistance from the county social service agency for adult protective services, the county social service agency shall immediately assess and offer emergency and continuing protective social services for purposes of preventing further maltreatment and for safeguarding the welfare of the maltreated vulnerable adult. The county shall use a standardized tool made available by the commissioner. The information entered by the county into the standardized tool must be accessible to the Department of Human Services. In cases of suspected sexual abuse, the county social service agency shall immediately arrange for and make available to the vulnerable adult appropriate medical examination and treatment. When necessary in order to protect the vulnerable adult from further harm, the county social service agency shall seek authority to remove the vulnerable adult from the situation in which the maltreatment occurred. The county social service agency
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may also investigate to determine whether the conditions which resulted in the reported maltreatment place other vulnerable adults in jeopardy of being maltreated and offer protective social services that are called for by its determination. (b) County social service agencies may enter facilities and inspect and copy records as part of an investigation. The county social service agency has access to not public data, as defined in section 13.02, and medical records under sections 144.291 to 144.298, that are maintained by facilities to the extent necessary to conduct its investigation. The inquiry is not limited to the written records of the facility, but may include every other available source of information. (c) When necessary in order to protect a vulnerable adult from serious harm, the county social service agency shall immediately intervene on behalf of that adult to help the family, vulnerable adult, or other interested person by seeking any of the following: (1) a restraining order or a court order for removal of the perpetrator from the residence of the vulnerable adult pursuant to section 518B.01; (2) the appointment of a guardian or conservator pursuant to sections 524.5-101 to 524.5-502, or guardianship or conservatorship pursuant to chapter 252A; (3) replacement of a guardian or conservator suspected of maltreatment and appointment of a suitable person as guardian or conservator, pursuant to sections 524.5-101 to 524.5-502; or (4) a referral to the prosecuting attorney for possible criminal prosecution of the perpetrator under chapter 609. The expenses of legal intervention must be paid by the county in the case of indigent persons, under section 524.5-502 and chapter 563. In proceedings under sections 524.5-101 to 524.5-502, if a suitable relative or other person is not available to petition for guardianship or conservatorship, a county employee shall present the petition with representation by the county attorney. The county shall contract with or arrange for a suitable person or organization to provide ongoing guardianship services. If the county presents evidence to the court exercising probate jurisdiction that it has made a diligent effort and no other suitable person can be found, a county employee may serve as guardian or conservator. The county shall not retaliate against the employee for any action taken on behalf of the ward or protected person even if the action is adverse to the county's interest. Any person retaliated against in violation of this subdivision shall have a cause of action against the county and shall be entitled to reasonable attorney fees and costs of the action if the action is upheld by the court. Subd. 10a. [Repealed, 1995 c 229 art 1 s 24] Subd. 10b. Investigations; guidelines. Each lead investigative agency shall develop guidelines for prioritizing reports for investigation. When investigating a report, the lead investigative agency shall conduct the following activities, as appropriate: (1) interview of the alleged victim; (2) interview of the reporter and others who may have relevant information; (3) interview of the alleged perpetrator; (4) examination of the environment surrounding the alleged incident;
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(5) review of pertinent documentation of the alleged incident; and (6) consultation with professionals. Subd. 11. [Repealed, 1995 c 229 art 1 s 24] Subd. 11a. [Repealed, 1995 c 229 art 1 s 24] Subd. 12. [Repealed, 1995 c 229 art 1 s 24] Subd. 12a. [Repealed, 1983 c 273 s 8] Subd. 12b. Data management. (a) In performing any of the duties of this section as a lead investigative agency, the county social service agency shall maintain appropriate records. Data collected by the county social service agency under this section are welfare data under section 13.46. Notwithstanding section 13.46, subdivision 1, paragraph (a), data under this paragraph that are inactive investigative data on an individual who is a vendor of services are private data on individuals, as defined in section 13.02. The identity of the reporter may only be disclosed as provided in paragraph (c). Data maintained by the common entry point are confidential data on individuals or protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163, the common entry point shall maintain data for three calendar years after date of receipt and then destroy the data unless otherwise directed by federal requirements. (b) The commissioners of health and human services shall prepare an investigation memorandum for each report alleging maltreatment investigated under this section. County social service agencies must maintain private data on individuals but are not required to prepare an investigation memorandum. During an investigation by the commissioner of health or the commissioner of human services, data collected under this section are confidential data on individuals or protected nonpublic data as defined in section 13.02. Upon completion of the investigation, the data are classified as provided in clauses (1) to (3) and paragraph (c). (1) The investigation memorandum must contain the following data, which are public: (i) the name of the facility investigated; (ii) a statement of the nature of the alleged maltreatment; (iii) pertinent information obtained from medical or other records reviewed; (iv) the identity of the investigator; (v) a summary of the investigation's findings; (vi) statement of whether the report was found to be substantiated, inconclusive, false, or that no determination will be made; (vii) a statement of any action taken by the facility; (viii) a statement of any action taken by the lead investigative agency; and (ix) when a lead investigative agency's determination has substantiated maltreatment, a statement of whether an individual, individuals, or a facility were responsible for the substantiated maltreatment, if known.
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The investigation memorandum must be written in a manner which protects the identity of the reporter and of the vulnerable adult and may not contain the names or, to the extent possible, data on individuals or private data listed in clause (2). (2) Data on individuals collected and maintained in the investigation memorandum are private data, including: (i) the name of the vulnerable adult; (ii) the identity of the individual alleged to be the perpetrator; (iii) the identity of the individual substantiated as the perpetrator; and (iv) the identity of all individuals interviewed as part of the investigation. (3) Other data on individuals maintained as part of an investigation under this section are private data on individuals upon completion of the investigation. (c) After the assessment or investigation is completed, the name of the reporter must be confidential. The subject of the report may compel disclosure of the name of the reporter only with the consent of the reporter or upon a written finding by a court that the report was false and there is evidence that the report was made in bad faith. This subdivision does not alter disclosure responsibilities or obligations under the Rules of Criminal Procedure, except that where the identity of the reporter is relevant to a criminal prosecution, the district court shall do an in-camera review prior to determining whether to order disclosure of the identity of the reporter. (d) Notwithstanding section 138.163, data maintained under this section by the commissioners of health and human services must be maintained under the following schedule and then destroyed unless otherwise directed by federal requirements: (1) data from reports determined to be false, maintained for three years after the finding was made; (2) data from reports determined to be inconclusive, maintained for four years after the finding was made; (3) data from reports determined to be substantiated, maintained for seven years after the finding was made; and (4) data from reports which were not investigated by a lead investigative agency and for which there is no final disposition, maintained for three years from the date of the report. (e) The commissioners of health and human services shall annually publish on their websites the number and type of reports of alleged maltreatment involving licensed facilities reported under this section, the number of those requiring investigation under this section, and the resolution of those investigations. On a biennial basis, the commissioners of health and human services shall jointly report the following information to the legislature and the governor: (1) the number and type of reports of alleged maltreatment involving licensed facilities reported under this section, the number of those requiring investigations under this section, the resolution of those investigations, and which of the two lead agencies was responsible; (2) trends about types of substantiated maltreatment found in the reporting period;
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(3) if there are upward trends for types of maltreatment substantiated, recommendations for addressing and responding to them; (4) efforts undertaken or recommended to improve the protection of vulnerable adults; (5) whether and where backlogs of cases result in a failure to conform with statutory time frames and recommendations for reducing backlogs if applicable; (6) recommended changes to statutes affecting the protection of vulnerable adults; and (7) any other information that is relevant to the report trends and findings. (f) Each lead investigative agency must have a record retention policy. (g) Lead investigative agencies, prosecuting authorities, and law enforcement agencies may exchange not public data, as defined in section 13.02, if the agency or authority requesting the data determines that the data are pertinent and necessary to the requesting agency in initiating, furthering, or completing an investigation under this section. Data collected under this section must be made available to prosecuting authorities and law enforcement officials, local county agencies, and licensing agencies investigating the alleged maltreatment under this section. The lead investigative agency shall exchange not public data with the vulnerable adult maltreatment review panel established in section 256.021 if the data are pertinent and necessary for a review requested under that section. Notwithstanding section 138.17, upon completion of the review, not public data received by the review panel must be destroyed. (h) Each lead investigative agency shall keep records of the length of time it takes to complete its investigations. (i) A lead investigative agency may notify other affected parties and their authorized representative if the lead investigative agency has reason to believe maltreatment has occurred and determines the information will safeguard the well-being of the affected parties or dispel widespread rumor or unrest in the affected facility. (j) Under any notification provision of this section, where federal law specifically prohibits the disclosure of patient identifying information, a lead investigative agency may not provide any notice unless the vulnerable adult has consented to disclosure in a manner which conforms to federal requirements. Subd. 13. [Repealed, 1995 c 229 art 1 s 24] Subd. 14. Abuse prevention plans. (a) Each facility, except home health agencies and personal care attendant services providers, shall establish and enforce an ongoing written abuse prevention plan. The plan shall contain an assessment of the physical plant, its environment, and its population identifying factors which may encourage or permit abuse, and a statement of specific measures to be taken to minimize the risk of abuse. The plan shall comply with any rules governing the plan promulgated by the licensing agency. (b) Each facility, including a home health care agency and personal care attendant services providers, shall develop an individual abuse prevention plan for each vulnerable adult residing there or receiving services from them. The plan shall contain an individualized assessment of: (1) the person's susceptibility to abuse by other individuals, including other vulnerable adults; (2) the person's risk of abusing other vulnerable adults; and (3) statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults. For the purposes of this paragraph, the term "abuse" includes self-abuse.
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(c) If the facility, except home health agencies and personal care attendant services providers, knows that the vulnerable adult has committed a violent crime or an act of physical aggression toward others, the individual abuse prevention plan must detail the measures to be taken to minimize the risk that the vulnerable adult might reasonably be expected to pose to visitors to the facility and persons outside the facility, if unsupervised. Under this section, a facility knows of a vulnerable adult's history of criminal misconduct or physical aggression if it receives such information from a law enforcement authority or through a medical record prepared by another facility, another health care provider, or the facility's ongoing assessments of the vulnerable adult. Subd. 15. [Repealed, 1995 c 229 art 1 s 24] Subd. 16. [Repealed, 2014 c 262 art 4 s 9] Subd. 17. Retaliation prohibited. (a) A facility or person shall not retaliate against any person who reports in good faith suspected maltreatment pursuant to this section, or against a vulnerable adult with respect to whom a report is made, because of the report. (b) In addition to any remedies allowed under sections 181.931 to 181.935, any facility or person which retaliates against any person because of a report of suspected maltreatment is liable to that person for actual damages, punitive damages up to $10,000, and attorney fees. (c) There shall be a rebuttable presumption that any adverse action, as defined below, within 90 days of a report, is retaliatory. For purposes of this clause, the term "adverse action" refers to action taken by a facility or person involved in a report against the person making the report or the person with respect to whom the report was made because of the report, and includes, but is not limited to: (1) discharge or transfer from the facility; (2) discharge from or termination of employment; (3) demotion or reduction in remuneration for services; (4) restriction or prohibition of access to the facility or its residents; or (5) any restriction of rights set forth in section 144.651. Subd. 18. Outreach. The commissioner of human services shall maintain an aggressive program to educate those required to report, as well as the general public, about the requirements of this section using a variety of media. The commissioner of human services shall print and make available the form developed under subdivision 9. Subd. 19. [Repealed, 1995 c 229 art 1 s 24] Subd. 20. Cause of action for financial exploitation; damages. (a) A vulnerable adult who is a victim of financial exploitation as defined in section 626.5572, subdivision 9, has a cause of action against a person who committed the financial exploitation. In an action under this subdivision, the vulnerable adult is entitled to recover damages equal to three times the amount of compensatory damages or $10,000, whichever is greater. (b) In addition to damages under paragraph (a), the vulnerable adult is entitled to recover reasonable attorney fees and costs, including reasonable fees for the services of a guardian or conservator or guardian ad litem incurred in connection with a claim under this subdivision.
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(c) An action may be brought under this subdivision regardless of whether there has been a report or final disposition under this section or a criminal complaint or conviction related to the financial exploitation. Subd. 21. Contested case hearing. When an appeal of a lead investigative agency determination results in a contested case hearing under chapter 245A or 245C, the administrative law judge shall notify the vulnerable adult who is the subject of the maltreatment determination and, if known, a guardian of the vulnerable adult appointed under section 524.5-310, or a health care agent designated by the vulnerable adult in a health care directive that is currently effective under section 145C.06, and whose authority to make health care decisions is not suspended under section 524.5-310, of the hearing. The notice must be sent by certified mail and inform the vulnerable adult of the right to file a signed written statement in the proceedings. A guardian or health care agent who prepares or files a written statement for the vulnerable adult must indicate in the statement that the person is the vulnerable adult's guardian or health care agent and sign the statement in that capacity. The vulnerable adult, the guardian, or the health care agent may file a written statement with the administrative law judge hearing the case no later than five business days before commencement of the hearing. The administrative law judge shall include the written statement in the hearing record and consider the statement in deciding the appeal. This subdivision does not limit, prevent, or excuse the vulnerable adult from being called as a witness testifying at the hearing or grant the vulnerable adult, the guardian, or health care agent a right to participate in the proceedings or appeal the administrative law judge's decision in the case. The lead investigative agency must consider including the vulnerable adult victim of maltreatment as a witness in the hearing. If the lead investigative agency determines that participation in the hearing would endanger the well-being of the vulnerable adult or not be in the best interests of the vulnerable adult, the lead investigative agency shall inform the administrative law judge of the basis for this determination, which must be included in the final order. If the administrative law judge is not reasonably able to determine the address of the vulnerable adult, the guardian, or the health care agent, the administrative law judge is not required to send a hearing notice under this subdivision. History: 1980 c 542 s 1; 1981 c 311 s 39; 1982 c 393 s 3,4; 1982 c 424 s 130; 1982 c 545 s 24; 1982 c 636 s 5,6; 1983 c 273 s 1-7; 1984 c 640 s 32; 1984 c 654 art 5 s 58; 1985 c 150 s 1-6; 1985 c 293 s 6,7; 1Sp1985 c 14 art 9 s 75; 1986 c 444; 1987 c 110 s 3; 1987 c 211 s 2; 1987 c 352 s 11; 1987 c 378 s 17; 1987 c 384 art 2 s 1; 1988 c 543 s 13; 1989 c 209 art 2 s 1; 1991 c 181 s 2; 1994 c 483 s 1; 1994 c 636 art 2 s 60-62; 1Sp1994 c 1 art 2 s 34; 1995 c 189 s 8; 1995 c 229 art 1 s 1-21; 1996 c 277 s 1; 1996 c 305 art 2 s 66; 2000 c 465 s 3-5; 1Sp2001 c 9 art 5 s 31; art 14 s 30,31; 2002 c 289 s 4; 2002 c 375 art 1 s 22,23; 2002 c 379 art 1 s 113; 2003 c 15 art 1 s 33; 2004 c 146 art 3 s 45; 2004 c 288 art 1 s 80; 2005 c 56 s 1; 2005 c 98 art 2 s 17; 2005 c 136 art 5 s 5; 1Sp2005 c 4 art 1 s 55,56; 2006 c 253 s 21; 2007 c 112 s 55,56; 2007 c 147 art 7 s 75; art 10 s 15; 2009 c 119 s 11-16; 2009 c 142 art 2 s 46,47; 2009 c 159 s 107; 2010 c 329 art 2 s 6; 2010 c 352 art 1 s 23; 2010 c 382 s 81; 2011 c 28 s 9-14,17; 2012 c 216 art 9 s 30,31; 2013 c 63 s 17; 2013 c 108 art 2 s 41-43; art 8 s 57; 2014 c 192 art 2 s 1; 2014 c 291 art 8 s 17; 2015 c 78 art 6 s 23-25; 2019 c 50 art 1 s 128
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626.5572 DEFINITIONS. Subdivision 1. Scope. For the purpose of section 626.557, the following terms have the meanings given them, unless otherwise specified. Subd. 2. Abuse. "Abuse" means: (a) An act against a vulnerable adult that constitutes a violation of, an attempt to violate, or aiding and abetting a violation of: (1) assault in the first through fifth degrees as defined in sections 609.221 to 609.224; (2) the use of drugs to injure or facilitate crime as defined in section 609.235; (3) the solicitation, inducement, and promotion of prostitution as defined in section 609.322; and (4) criminal sexual conduct in the first through fifth degrees as defined in sections 609.342 to 609.3451. A violation includes any action that meets the elements of the crime, regardless of whether there is a criminal proceeding or conviction. (b) Conduct which is not an accident or therapeutic conduct as defined in this section, which produces or could reasonably be expected to produce physical pain or injury or emotional distress including, but not limited to, the following: (1) hitting, slapping, kicking, pinching, biting, or corporal punishment of a vulnerable adult; (2) use of repeated or malicious oral, written, or gestured language toward a vulnerable adult or the treatment of a vulnerable adult which would be considered by a reasonable person to be disparaging, derogatory, humiliating, harassing, or threatening; (3) use of any aversive or deprivation procedure, unreasonable confinement, or involuntary seclusion, including the forced separation of the vulnerable adult from other persons against the will of the vulnerable adult or the legal representative of the vulnerable adult; and (4) use of any aversive or deprivation procedures for persons with developmental disabilities or related conditions not authorized under section 245.825. (c) Any sexual contact or penetration as defined in section 609.341, between a facility staff person or a person providing services in the facility and a resident, patient, or client of that facility. (d) The act of forcing, compelling, coercing, or enticing a vulnerable adult against the vulnerable adult's will to perform services for the advantage of another. (e) For purposes of this section, a vulnerable adult is not abused for the sole reason that the vulnerable adult or a person with authority to make health care decisions for the vulnerable adult under sections 144.651, 144A.44, chapter 145B, 145C or 252A, or section 253B.03 or 524.5-313, refuses consent or withdraws consent, consistent with that authority and within the boundary of reasonable medical practice, to any therapeutic conduct, including any care, service, or procedure to diagnose, maintain, or treat the physical or mental condition of the vulnerable adult or, where permitted under law, to provide nutrition and hydration parenterally or through intubation. This paragraph does not enlarge or diminish rights otherwise held under law by:
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(1) a vulnerable adult or a person acting on behalf of a vulnerable adult, including an involved family member, to consent to or refuse consent for therapeutic conduct; or (2) a caregiver to offer or provide or refuse to offer or provide therapeutic conduct. (f) For purposes of this section, a vulnerable adult is not abused for the sole reason that the vulnerable adult, a person with authority to make health care decisions for the vulnerable adult, or a caregiver in good faith selects and depends upon spiritual means or prayer for treatment or care of disease or remedial care of the vulnerable adult in lieu of medical care, provided that this is consistent with the prior practice or belief of the vulnerable adult or with the expressed intentions of the vulnerable adult. (g) For purposes of this section, a vulnerable adult is not abused for the sole reason that the vulnerable adult, who is not impaired in judgment or capacity by mental or emotional dysfunction or undue influence, engages in consensual sexual contact with: (1) a person, including a facility staff person, when a consensual sexual personal relationship existed prior to the caregiving relationship; or (2) a personal care attendant, regardless of whether the consensual sexual personal relationship existed prior to the caregiving relationship. Subd. 3. Accident. "Accident" means a sudden, unforeseen, and unexpected occurrence or event which: (1) is not likely to occur and which could not have been prevented by exercise of due care; and (2) if occurring while a vulnerable adult is receiving services from a facility, happens when the facility and the employee or person providing services in the facility are in compliance with the laws and rules relevant to the occurrence or event. Subd. 4. Caregiver. "Caregiver" means an individual or facility who has responsibility for the care of a vulnerable adult as a result of a family relationship, or who has assumed responsibility for all or a portion of the care of a vulnerable adult voluntarily, by contract, or by agreement. Subd. 5. Common entry point. "Common entry point" means the entity responsible for receiving reports of alleged or suspected maltreatment of a vulnerable adult under section 626.557. Subd. 6. Facility. (a) "Facility" means a hospital or other entity required to be licensed under sections 144.50 to 144.58; a nursing home required to be licensed to serve adults under section 144A.02; a facility or service required to be licensed under chapter 245A; an assisted living facility required to be licensed under chapter 144G; a home care provider licensed or required to be licensed under sections 144A.43 to 144A.482; a hospice provider licensed under sections 144A.75 to 144A.755; or a person or organization that offers, provides, or arranges for personal care assistance services under the medical assistance program as authorized under sections 256B.0625, subdivision 19a, 256B.0651 to 256B.0654, 256B.0659, or 256B.85. (b) For services identified in paragraph (a) that are provided in the vulnerable adult's own home or in another unlicensed location, the term "facility" refers to the provider, person, or organization that offers, provides, or arranges for personal care services, and does not refer to the vulnerable adult's home or other location at which services are rendered. Subd. 7. False. "False" means a preponderance of the evidence shows that an act that meets the definition of maltreatment did not occur.
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Subd. 8. Final disposition. "Final disposition" is the determination of an investigation by a lead investigative agency that a report of maltreatment under Laws 1995, chapter 229, is substantiated, inconclusive, false, or that no determination will be made. When a lead investigative agency determination has substantiated maltreatment, the final disposition also identifies, if known, which individual or individuals were responsible for the substantiated maltreatment, and whether a facility was responsible for the substantiated maltreatment. Subd. 9. Financial exploitation. "Financial exploitation" means: (a) In breach of a fiduciary obligation recognized elsewhere in law, including pertinent regulations, contractual obligations, documented consent by a competent person, or the obligations of a responsible party under section 144.6501, a person: (1) engages in unauthorized expenditure of funds entrusted to the actor by the vulnerable adult which results or is likely to result in detriment to the vulnerable adult; or (2) fails to use the financial resources of the vulnerable adult to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the vulnerable adult, and the failure results or is likely to result in detriment to the vulnerable adult. (b) In the absence of legal authority a person: (1) willfully uses, withholds, or disposes of funds or property of a vulnerable adult; (2) obtains for the actor or another the performance of services by a third person for the wrongful profit or advantage of the actor or another to the detriment of the vulnerable adult; (3) acquires possession or control of, or an interest in, funds or property of a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud; or (4) forces, compels, coerces, or entices a vulnerable adult against the vulnerable adult's will to perform services for the profit or advantage of another. (c) Nothing in this definition requires a facility or caregiver to provide financial management or supervise financial management for a vulnerable adult except as otherwise required by law. Subd. 10. Immediately. "Immediately" means as soon as possible, but no longer than 24 hours from the time initial knowledge that the incident occurred has been received. Subd. 11. Inconclusive. "Inconclusive" means there is less than a preponderance of evidence to show that maltreatment did or did not occur. Subd. 12. Initial disposition. "Initial disposition" is the lead investigative agency's determination of whether the report will be assigned for further investigation. Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary administrative agency responsible for investigating reports made under section 626.557. (a) The Department of Health is the lead investigative agency for facilities or services licensed or required to be licensed as hospitals, home care providers, nursing homes, boarding care homes, hospice providers, residential facilities that are also federally certified as intermediate care facilities that serve people with developmental disabilities, or any other facility or service not listed in this subdivision that is licensed or required to be licensed by the Department of Health for the care of vulnerable adults. "Home care provider" has the meaning provided in section 144A.43, subdivision 4, and applies when care or services are delivered
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in the vulnerable adult's home, whether a private home or a housing with services establishment registered under chapter 144D, including those that offer assisted living services under chapter 144G. (b) The Department of Human Services is the lead investigative agency for facilities or services licensed or required to be licensed as adult day care, adult foster care, community residential settings, programs for people with disabilities, family adult day services, mental health programs, mental health clinics, chemical dependency programs, the Minnesota sex offender program, or any other facility or service not listed in this subdivision that is licensed or required to be licensed by the Department of Human Services. (c) The county social service agency or its designee is the lead investigative agency for all other reports, including, but not limited to, reports involving vulnerable adults receiving services from a personal care provider organization under section 256B.0659. Subd. 14. Legal authority. "Legal authority" includes, but is not limited to: (1) a fiduciary obligation recognized elsewhere in law, including pertinent regulations; (2) a contractual obligation; or (3) documented consent by a competent person. Subd. 15. Maltreatment. "Maltreatment" means abuse as defined in subdivision 2, neglect as defined in subdivision 17, or financial exploitation as defined in subdivision 9. Subd. 16. Mandated reporter. "Mandated reporter" means a professional or professional's delegate while engaged in: (1) social services; (2) law enforcement; (3) education; (4) the care of vulnerable adults; (5) any of the occupations referred to in section 214.01, subdivision 2; (6) an employee of a rehabilitation facility certified by the commissioner of jobs and training for vocational rehabilitation; (7) an employee or person providing services in a facility as defined in subdivision 6; or (8) a person that performs the duties of the medical examiner or coroner. Subd. 17. Neglect. "Neglect" means: (a) The failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to, food, clothing, shelter, health care, or supervision which is: (1) reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult; and (2) which is not the result of an accident or therapeutic conduct. (b) The absence or likelihood of absence of care or services, including but not limited to, food, clothing, shelter, health care, or supervision necessary to maintain the physical and mental health of the vulnerable adult which a reasonable person would deem essential to obtain or maintain the vulnerable adult's health, safety, or comfort considering the physical or mental capacity or dysfunction of the vulnerable adult. (c) For purposes of this section, a vulnerable adult is not neglected for the sole reason that: (1) the vulnerable adult or a person with authority to make health care decisions for the vulnerable adult under sections 144.651, 144A.44, chapter 145B, 145C, or 252A, or sections 253B.03 or 524.5-101 to 524.5-502, refuses consent or withdraws consent, consistent with that authority and within the boundary of reasonable medical practice, to any therapeutic conduct, including any care, service, or procedure to diagnose, maintain, or treat the physical or mental condition of the vulnerable adult, or, where permitted under law, to provide nutrition and hydration parenterally or through intubation; this paragraph does not enlarge or diminish rights otherwise held under law by:
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(i) a vulnerable adult or a person acting on behalf of a vulnerable adult, including an involved family member, to consent to or refuse consent for therapeutic conduct; or (ii) a caregiver to offer or provide or refuse to offer or provide therapeutic conduct; or (2) the vulnerable adult, a person with authority to make health care decisions for the vulnerable adult, or a caregiver in good faith selects and depends upon spiritual means or prayer for treatment or care of disease or remedial care of the vulnerable adult in lieu of medical care, provided that this is consistent with the prior practice or belief of the vulnerable adult or with the expressed intentions of the vulnerable adult; (3) the vulnerable adult, who is not impaired in judgment or capacity by mental or emotional dysfunction or undue influence, engages in consensual sexual contact with: (i) a person including a facility staff person when a consensual sexual personal relationship existed prior to the caregiving relationship; or (ii) a personal care attendant, regardless of whether the consensual sexual personal relationship existed prior to the caregiving relationship; or (4) an individual makes an error in the provision of therapeutic conduct to a vulnerable adult which does not result in injury or harm which reasonably requires medical or mental health care; or (5) an individual makes an error in the provision of therapeutic conduct to a vulnerable adult that results in injury or harm, which reasonably requires the care of a physician, and: (i) the necessary care is provided in a timely fashion as dictated by the condition of the vulnerable adult; (ii) if after receiving care, the health status of the vulnerable adult can be reasonably expected, as determined by the attending physician, to be restored to the vulnerable adult's preexisting condition; (iii) the error is not part of a pattern of errors by the individual; (iv) if in a facility, the error is immediately reported as required under section 626.557, and recorded internally in the facility; (v) if in a facility, the facility identifies and takes corrective action and implements measures designed to reduce the risk of further occurrence of this error and similar errors; and (vi) if in a facility, the actions required under items (iv) and (v) are sufficiently documented for review and evaluation by the facility and any applicable licensing, certification, and ombudsman agency. (d) Nothing in this definition requires a caregiver, if regulated, to provide services in excess of those required by the caregiver's license, certification, registration, or other regulation. (e) If the findings of an investigation by a lead investigative agency result in a determination of substantiated maltreatment for the sole reason that the actions required of a facility under paragraph (c), clause (5), item (iv), (v), or (vi), were not taken, then the facility is subject to a correction order. An individual will not be found to have neglected or maltreated the vulnerable adult based solely on the facility's not having taken the actions required under paragraph (c), clause (5), item (iv), (v), or (vi). This must not alter the lead investigative agency's determination of mitigating factors under section 626.557, subdivision 9c, paragraph (c).
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Subd. 18. Report. "Report" means a statement concerning all the circumstances surrounding the alleged or suspected maltreatment, as defined in this section, of a vulnerable adult which are known to the reporter at the time the statement is made. Subd. 19. Substantiated. "Substantiated" means a preponderance of the evidence shows that an act that meets the definition of maltreatment occurred. Subd. 20. Therapeutic conduct. "Therapeutic conduct" means the provision of program services, health care, or other personal care services done in good faith in the interests of the vulnerable adult by: (1) an individual, facility, or employee or person providing services in a facility under the rights, privileges and responsibilities conferred by state license, certification, or registration; or (2) a caregiver. Subd. 21. Vulnerable adult. (a) "Vulnerable adult" means any person 18 years of age or older who: (1) is a resident or inpatient of a facility; (2) receives services required to be licensed under chapter 245A, except that a person receiving outpatient services for treatment of chemical dependency or mental illness, or one who is served in the Minnesota sex offender program on a court-hold order for commitment, or is committed as a sexual psychopathic personality or as a sexually dangerous person under chapter 253B, is not considered a vulnerable adult unless the person meets the requirements of clause (4); (3) receives services from a home care provider required to be licensed under sections 144A.43 to 144A.482; or from a person or organization that offers, provides, or arranges for personal care assistance services under the medical assistance program as authorized under section 256B.0625, subdivision 19a, 256B.0651, 256B.0653, 256B.0654, 256B.0659, or 256B.85; or (4) regardless of residence or whether any type of service is received, possesses a physical or mental infirmity or other physical, mental, or emotional dysfunction: (i) that impairs the individual's ability to provide adequately for the individual's own care without assistance, including the provision of food, shelter, clothing, health care, or supervision; and (ii) because of the dysfunction or infirmity and the need for care or services, the individual has an impaired ability to protect the individual's self from maltreatment. (b) For purposes of this subdivision, "care or services" means care or services for the health, safety, welfare, or maintenance of an individual. History: 1995 c 229 art 1 s 22; 2000 c 319 s 3; 1Sp2001 c 9 art 14 s 32; 2002 c 252 s 23,24; 2002 c 379 art 1 s 113; 2004 c 146 art 3 s 46; 2006 c 212 art 3 s 41; 2007 c 112 s 57; 2008 c 326 art 2 s 15; 2009 c 79 art 6 s 20,21; art 8 s 75; 2009 c 119 s 17; 2009 c 142 art 2 s 48; 2011 c 28 s 16,17; 2012 c 216 art 9 s 32; 2013 c 108 art 8 s 58; 2014 c 262 art 4 s 9; art 5 s 6; 2015 c 78 art 6 s 26-28; 2016 c 158 art 1 s 210,211; 2019 c 60 art 1 s 47; art 4 s 33
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144.6502 ELECTRONIC MONITORING IN CERTAIN FACILITIES. Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in this subdivision have the meanings given. (b) "Commissioner" means the commissioner of health. (c) "Department" means the Department of Health. (d) "Electronic monitoring" means the placement and use of an electronic monitoring device by a resident in the resident's room or private living unit in accordance with this section. (e) "Electronic monitoring device" means a camera or other device that captures, records, or broadcasts audio, video, or both, that is placed in a resident's room or private living unit and is used to monitor the resident or activities in the room or private living unit. (f) "Facility" means a facility that is: (1) licensed as a nursing home under chapter 144A; (2) licensed as a boarding care home under sections 144.50 to 144.56; (3) until August 1, 2021, a housing with services establishment registered under chapter 144D that is either subject to chapter 144G or has a disclosed special unit under section 325F.72; or (4) on or after August 1, 2021, an assisted living facility. (g) "Resident" means a person 18 years of age or older residing in a facility. (h) "Resident representative" means one of the following in the order of priority listed, to the extent the person may reasonably be identified and located: (1) a court-appointed guardian; (2) a health care agent as defined in section 145C.01, subdivision 2; or (3) a person who is not an agent of a facility or of a home care provider designated in writing by the resident and maintained in the resident's records on file with the facility. Subd. 2. Electronic monitoring authorized. (a) A resident or a resident representative may conduct electronic monitoring of the resident's room or private living unit through the use of electronic monitoring devices placed in the resident's room or private living unit as provided in this section. (b) Nothing in this section precludes the use of electronic monitoring of health care allowed under other law. (c) Electronic monitoring authorized under this section is not a covered service under home and community-based waivers under chapter 256S and sections 256B.0913, 256B.092, and 256B.49. (d) This section does not apply to monitoring technology authorized as a home and community-based service under chapter 256S or section 256B.0913, 256B.092, or 256B.49. Subd. 3. Consent to electronic monitoring. (a) Except as otherwise provided in this subdivision, a resident must consent to electronic monitoring in the resident's room or private living unit in writing on a notification and consent form. If the resident has not affirmatively objected to electronic monitoring and the
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resident's medical professional determines that the resident currently lacks the ability to understand and appreciate the nature and consequences of electronic monitoring, the resident representative may consent on behalf of the resident. For purposes of this subdivision, a resident affirmatively objects when the resident orally, visually, or through the use of auxiliary aids or services declines electronic monitoring. The resident's response must be documented on the notification and consent form. (b) Prior to a resident representative consenting on behalf of a resident, the resident must be asked if the resident wants electronic monitoring to be conducted. The resident representative must explain to the resident: (1) the type of electronic monitoring device to be used; (2) the standard conditions that may be placed on the electronic monitoring device's use, including those listed in subdivision 6; (3) with whom the recording may be shared under subdivision 10 or 11; and (4) the resident's ability to decline all recording. (c) A resident, or resident representative when consenting on behalf of the resident, may consent to electronic monitoring with any conditions of the resident's or resident representative's choosing, including the list of standard conditions provided in subdivision 6. A resident, or resident representative when consenting on behalf of the resident, may request that the electronic monitoring device be turned off or the visual or audio recording component of the electronic monitoring device be blocked at any time. (d) Prior to implementing electronic monitoring, a resident, or resident representative when acting on behalf of the resident, must obtain the written consent on the notification and consent form of any other resident residing in the shared room or shared private living unit. A roommate's or roommate's resident representative's written consent must comply with the requirements of paragraphs (a) to (c). Consent by a roommate or a roommate's resident representative under this paragraph authorizes the resident's use of any recording obtained under this section, as provided under subdivision 10 or 11. (e) Any resident conducting electronic monitoring must immediately remove or disable an electronic monitoring device prior to a new roommate moving into a shared room or shared private living unit, unless the resident obtains the roommate's or roommate's resident representative's written consent as provided under paragraph (d) prior to the roommate moving into the shared room or shared private living unit. Upon obtaining the new roommate's signed notification and consent form and submitting the form to the facility as required under subdivision 5, the resident may resume electronic monitoring. (f) The resident or roommate, or the resident representative or roommate's resident representative if the representative is consenting on behalf of the resident or roommate, may withdraw consent at any time and the withdrawal of consent must be documented on the original consent form as provided under subdivision 5, paragraph (d). Subd. 4. Refusal of roommate to consent. If a resident of a facility who is residing in a shared room or shared living unit, or the resident representative of such a resident when acting on behalf of the resident, wants to conduct electronic monitoring and another resident living in or moving into the same shared room or shared living unit refuses to consent to the use of an electronic monitoring device, the facility shall make a reasonable attempt to accommodate the resident who wants to conduct electronic monitoring. A facility has met the requirement to make a reasonable attempt to accommodate a resident or resident representative who wants to conduct electronic monitoring when, upon notification that a roommate has not consented to the use of an electronic monitoring device in the resident's room, the facility offers to move the resident to
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another shared room or shared living unit that is available at the time of the request. If a resident chooses to reside in a private room or private living unit in a facility in order to accommodate the use of an electronic monitoring device, the resident must pay either the private room rate in a nursing home setting, or the applicable rent in a housing with services establishment or assisted living facility. If a facility is unable to accommodate a resident due to lack of space, the facility must reevaluate the request every two weeks until the request is fulfilled. A facility is not required to provide a private room, a single-bed room, or a private living unit to a resident who is unable to pay. Subd. 5. Notice to facility; exceptions. (a) Electronic monitoring may begin only after the resident or resident representative who intends to place an electronic monitoring device and any roommate or roommate's resident representative completes the notification and consent form and submits the form to the facility. (b) Notwithstanding paragraph (a), the resident or resident representative who intends to place an electronic monitoring device may do so without submitting a notification and consent form to the facility for up to 14 days: (1) if the resident or the resident representative reasonably fears retaliation against the resident by the facility, timely submits the completed notification and consent form to the Office of Ombudsman for Long-Term Care, and timely submits a Minnesota Adult Abuse Reporting Center report or police report, or both, upon evidence from the electronic monitoring device that suspected maltreatment has occurred; (2) if there has not been a timely written response from the facility to a written communication from the resident or resident representative expressing a concern prompting the desire for placement of an electronic monitoring device and if the resident or a resident representative timely submits a completed notification and consent form to the Office of Ombudsman for Long-Term Care; or (3) if the resident or resident representative has already submitted a Minnesota Adult Abuse Reporting Center report or police report regarding the resident's concerns prompting the desire for placement and if the resident or a resident representative timely submits a completed notification and consent form to the Office of Ombudsman for Long-Term Care. (c) Upon receipt of any completed notification and consent form, the facility must place the original form in the resident's file or file the original form with the resident's housing with services contract. The facility must provide a copy to the resident and the resident's roommate, if applicable. (d) If a resident is conducting electronic monitoring according to paragraph (b) and a new roommate moves into the room or living unit, the resident or resident representative must submit the signed notification and consent form to the facility. In the event that a resident or roommate, or the resident representative or roommate's resident representative if the representative is consenting on behalf of the resident or roommate, chooses to alter the conditions under which consent to electronic monitoring is given or chooses to withdraw consent to electronic monitoring, the facility must make available the original notification and consent form so that it may be updated. Upon receipt of the updated form, the facility must place the updated form in the resident's file or file the original form with the resident's signed housing with services contract. The facility must provide a copy of the updated form to the resident and the resident's roommate, if applicable. (e) If a new roommate, or the new roommate's resident representative when consenting on behalf of the new roommate, does not submit to the facility a completed notification and consent form and the resident conducting the electronic monitoring does not remove or disable the electronic monitoring device, the facility must remove the electronic monitoring device.
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(f) If a roommate, or the roommate's resident representative when withdrawing consent on behalf of the roommate, submits an updated notification and consent form withdrawing consent and the resident conducting electronic monitoring does not remove or disable the electronic monitoring device, the facility must remove the electronic monitoring device. Subd. 6. Form requirements. (a) The notification and consent form completed by the resident must include, at a minimum, the following information: (1) the resident's signed consent to electronic monitoring or the signature of the resident representative, if applicable. If a person other than the resident signs the consent form, the form must document the following: (i) the date the resident was asked if the resident wants electronic monitoring to be conducted; (ii) who was present when the resident was asked; (iii) an acknowledgment that the resident did not affirmatively object; and (iv) the source of authority allowing the resident representative to sign the notification and consent form on the resident's behalf; (2) the resident's roommate's signed consent or the signature of the roommate's resident representative, if applicable. If a roommate's resident representative signs the consent form, the form must document the following: (i) the date the roommate was asked if the roommate wants electronic monitoring to be conducted; (ii) who was present when the roommate was asked; (iii) an acknowledgment that the roommate did not affirmatively object; and (iv) the source of authority allowing the resident representative to sign the notification and consent form on the roommate's behalf; (3) the type of electronic monitoring device to be used; (4) a list of standard conditions or restrictions that the resident or a roommate may elect to place on the use of the electronic monitoring device, including but not limited to: (i) prohibiting audio recording; (ii) prohibiting video recording; (iii) prohibiting broadcasting of audio or video; (iv) turning off the electronic monitoring device or blocking the visual recording component of the electronic monitoring device for the duration of an exam or procedure by a health care professional; (v) turning off the electronic monitoring device or blocking the visual recording component of the electronic monitoring device while dressing or bathing is performed; and (vi) turning off the electronic monitoring device for the duration of a visit with a spiritual adviser, ombudsman, attorney, financial planner, intimate partner, or other visitor; (5) any other condition or restriction elected by the resident or roommate on the use of an electronic monitoring device;
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(6) a statement of the circumstances under which a recording may be disseminated under subdivision 10; (7) a signature box for documenting that the resident or roommate has withdrawn consent; and (8) an acknowledgment that the resident consents to the Office of Ombudsman for Long-Term Care and its representatives disclosing information about the form. Disclosure under this clause shall be limited to: (i) the fact that the form was received from the resident or resident representative; (ii) if signed by a resident representative, the name of the resident representative and the source of authority allowing the resident representative to sign the notification and consent form on the resident's behalf; and (iii) the type of electronic monitoring device placed. (b) Facilities must make the notification and consent form available to the residents and inform residents of their option to conduct electronic monitoring of their rooms or private living unit. (c) Notification and consent forms received by the Office of Ombudsman for Long-Term Care are classified under section 256.9744. (d) A facility that contacts the Office of Ombudsman for Long-Term Care regarding an electronic monitoring device presumably placed in accordance with subdivision 5, paragraph (a) or (b), must provide the office with the type, make, and model number of the electronic monitoring device discovered by the facility. Subd. 7. Costs and installation. (a) A resident or resident representative choosing to conduct electronic monitoring must do so at the resident's own expense, including paying purchase, installation, maintenance, and removal costs. (b) If a resident chooses to place an electronic monitoring device that uses Internet technology for visual or audio monitoring, the resident may be responsible for contracting with an Internet service provider. (c) The facility shall make a reasonable attempt to accommodate the resident's installation needs, including allowing access to the facility's public-use Internet or Wi-Fi systems when available for other public uses. A facility has the burden of proving that a requested accommodation is not reasonable. (d) All electronic monitoring device installations and supporting services must be UL-listed. Subd. 8. Notice to visitors. (a) A facility must post a sign at each facility entrance accessible to visitors that states: "Electronic monitoring devices, including security cameras and audio devices, may be present to record persons and activities." (b) The facility is responsible for installing and maintaining the signage required in this subdivision. Subd. 9. Obstruction of electronic monitoring devices. (a) A person must not knowingly hamper, obstruct, tamper with, or destroy an electronic monitoring device placed in a resident's room or private living unit without the permission of the resident or resident representative. Checking the electronic monitoring device by facility staff for the make and model number does not constitute tampering under this subdivision. (b) It is not a violation of paragraph (a) if a person turns off the electronic monitoring device or blocks the visual recording component of the electronic monitoring device at the direction of the resident or resident representative, or if consent has been withdrawn.
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Subd. 10. Dissemination of recordings. (a) No person may access any video or audio recording created through authorized electronic monitoring without the written consent of the resident or resident representative. (b) Except as required under other law, a recording or copy of a recording made as provided in this section may only be disseminated for the purpose of addressing health, safety, or welfare concerns of one or more residents. (c) A person disseminating a recording or copy of a recording made as provided in this section in violation of paragraph (b) may be civilly or criminally liable. Subd. 11. Admissibility of evidence. Subject to applicable rules of evidence and procedure, any video or audio recording created through electronic monitoring under this section may be admitted into evidence in a civil, criminal, or administrative proceeding. Subd. 12. Liability. (a) For the purposes of state law, the mere presence of an electronic monitoring device in a resident's room or private living unit is not a violation of the resident's right to privacy under section 144.651 or 144A.44. (b) For the purposes of state law, a facility or home care provider is not civilly or criminally liable for the mere disclosure by a resident or a resident representative of a recording. Subd. 13. Immunity from liability. The Office of Ombudsman for Long-Term Care and representatives of the office are immune from liability for conduct described in section 256.9742, subdivision 2. Subd. 14. Resident protections. (a) A facility must not: (1) refuse to admit a potential resident or remove a resident because the facility disagrees with the decision of the potential resident, the resident, or a resident representative acting on behalf of the resident regarding electronic monitoring; (2) retaliate or discriminate against any resident for consenting or refusing to consent to electronic monitoring, as provided in section 144.6512, 144G.07, or 144G.92; or (3) prevent the placement or use of an electronic monitoring device by a resident who has provided the facility or the Office of Ombudsman for Long-Term Care with notice and consent as required under this section. (b) Any contractual provision prohibiting, limiting, or otherwise modifying the rights and obligations in this section is contrary to public policy and is void and unenforceable. Subd. 15. Employee discipline. (a) An employee of the facility or an employee of a contractor providing services at the facility, including an arranged home care provider as defined in section 144D.01, subdivision 2a, who is the subject of proposed disciplinary action based upon evidence obtained by electronic monitoring must be given access to that evidence for purposes of defending against the proposed action. (b) An employee who obtains a recording or a copy of the recording must treat the recording or copy confidentially and must not further disseminate it to any other person except as required under law. Any copy of the recording must be returned to the facility or resident who provided the copy when it is no longer needed for purposes of defending against a proposed action. Subd. 16. Penalties. (a) The commissioner may issue a correction order as provided under section 144A.10, 144A.45, 144A.474, or 144G.30, upon a finding that the facility has failed to comply with:
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(1) subdivision 5, paragraphs (c) to (f); (2) subdivision 6, paragraph (b); (3) subdivision 7, paragraph (c); or (4) subdivision 8, 9, 10, or 14. (b) For each violation of this section, the commissioner may impose a fine of up to $500 upon a finding of noncompliance with a correction order issued under this subdivision. (c) The commissioner may exercise the commissioner's authority under section 144D.05 to compel a housing with services establishment to meet the requirements of this section. History: 2019 c 54 art 1 s 33; 2019 c 60 art 1 s 47; art 3 s 1; 1Sp2019 c 9 art 11 s 105
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325F.72 DISCLOSURE OF SPECIAL CARE STATUS REQUIRED. Subdivision 1. Persons to whom disclosure is required. Only assisted living facilities with dementia care licenses under chapter 144G may advertise, market, or otherwise promote the facility as providing specialized care for dementia or related disorders. All assisted living facilities with dementia care licenses shall provide a written disclosure to the following: (1) the commissioner of health, if requested; (2) the Office of Ombudsman for Long-Term Care; and (3) each person seeking placement within a residence, or the person's legal and designated representatives, as those terms are defined in section 144G.08, before an agreement to provide the care is entered into. [See Note.] Subd. 2. Content. Written disclosure shall include, but is not limited to, the following: (1) a statement of the overall philosophy and how it reflects the special needs of residents with Alzheimer's disease or other dementias; (2) the criteria for determining who may reside in the secured dementia care unit as defined in section 144G.08, subdivision 62; (3) the process used for assessment and establishment of the service plan, including how the plan is responsive to changes in the resident's condition; (4) staffing credentials, job descriptions, and staff duties and availability, including any training specific to dementia; (5) physical environment as well as design and security features that specifically address the needs of residents with Alzheimer's disease or other dementias; (6) frequency and type of programs and activities for residents of the assisted living facility with dementia care; (7) involvement of families in resident care and availability of family support programs; (8) fee schedules for additional services to the residents of the secured dementia care unit; and (9) a statement that residents will be given a written notice 30 calendar days prior to changes in the fee schedule. [See Note.] Subd. 3. Duty to update. Substantial changes to disclosures must be reported to the parties listed in subdivision 1 at the time the change is made. Subd. 4. Remedy. The attorney general may seek the remedies set forth in section 8.31 for repeated and intentional violations of this section. However, no private right of action may be maintained as provided under section 8.31, subdivision 3a. History: 1Sp2001 c 9 art 1 s 57; 2002 c 379 art 1 s 113; 2007 c 147 art 7 s 75; 2019 c 60 art 1 s 47; art 4 s 31,32
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NOTE: The amendments to subdivisions 1 and 2 by Laws 2019, chapter 60, article 4, sections 31 and 32, are effective August 1, 2021. Laws 2019, chapter 60, article 4, sections 31 and 32, the effective dates.
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Statement of Home Care Services Comprehensive Home Care Provider Comprehensive Home Care Provider Name: Below is a list of all services that may be provided with a Comprehensive Home Care License. Each service that is offered by this provider is indicated by a check in the box next to the service. Advanced Practice Nurse Services
Complex or Specialty Healthcare Services
Registered Nurse Services
Assistance with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing
Licensed Practical Nurse Services Physical Therapy Services Occupational Therapy Services Speech Language Pathologist Services Respiratory Therapy Services Social Worker Services Services by a Dietitian or Nutritionist Medication Management Services Delegated tasks to unlicensed personnel Hands-on assistance with transfers and mobility Providing eating assistance for clients with complicating eating problems (i.e. difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube, parenteral or intravenous instruments)
Providing standby assistance within arm’s reach for safety while performing daily activities Providing verbal or visual reminders to take regularly scheduled medication (includes bringing clients previously set-up medication, medication in original containers, or liquid or food to accompany the medication) Providing verbal or visual reminders to the client to perform regularly scheduled treatments and exercises Preparing modified diets ordered by licensed health professional Laundry Housekeeping/Other household chores Meal preparation Shopping
I have received a copy of this Statement of Home Care Services: Client Signature: ____________________________________________ Date: ___________________
Statement of Home Care Services – Comprehensive Home Care Provider (12/13)
2021 NURSE MANAGERS’ EDUCATION SERIES
Select MDH Website References Housing with Services Housing with Services Registration form http://www.health.state.mn.us/divs/fpc/profinfo/lic/fpc926_1.pdf Local Requirements Addendum to the HWS Registration form http://www.health.state.mn.us/divs/fpc/profinfo/lic/hwsaddendum.pdf Uniform Consumer Information Guide (UCIG) http://www.health.state.mn.us/divs/fpc/profinfo/lic/UCIguide.html Related Housing with Services/Assisted Living/UCIG Statutes 144D ‐ http://www.revisor.leg.state.mn.us/stats/144D/ 144G ‐ http://www.revisor.leg.state.mn.us/stats/144G/ Special Care Units ‐ https://www.revisor.mn.gov/statutes/?id=325F.72
Comprehensive and Basic Home Care Comprehensive Home Care Licensing http://www.health.state.mn.us/divs/fpc/homecare/index.html Comprehensive Home Care Statement of Home Care Services http://www.health.state.mn.us/divs/fpc/homecare/providers/compstatementserv.pdf Basic Home Care Licensing http://www.health.state.mn.us/divs/fpc/homecare/index.html Basic Home Care Statement of Home Care Services http://www.health.state.mn.us/divs/fpc/homecare/providers/basicstatementserv.pdf Forms for Home Care Providers http://www.health.state.mn.us/divs/fpc/homecare/providers/forms.html
Bill of Rights http://www.health.state.mn.us/divs/fpc/consumerinfo/index.html
2021 NURSE MANAGERS’ EDUCATION SERIES
MN Vulnerable Adults Act Reporting Refer to Appendix A for the current Minnesota Vulnerable Adults Act statute.
However, note that effective July 1, 2015, the referenced Common Entry Point (CEP) system has been replaced with the Minnesota Adult Abuse Reporting Center (MAARC).
Statewide 24/7/365 contact information for MAARC is:
mn.gov.dhs/reportadultabuse
2021 NURSE MANAGERS’ EDUCATION SERIES
2021 NURSE MANAGERS’ EDUCATION SERIES
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 DHS 02/11/2020
SD# 1
EW RS Rates
Information from Individual's Screening Document FALSE
SD# 4
Version
PMI
Client Last Name
Assigned SD#
Client First Name
Assessment/Change Date
Street Address
76
City
Assess. Effective Date
CL Start Date
CL End Date Max Start Date=06/30/2020
13
County of Residence
Prior Rate Use
State
Full monthly CL Rate on 01/00/1900
Zip
Has Prior Tool 16
DOB
Primary Diagnosis Health Plan
22
Case Manager's Name
+NPI
0
SD# 38
Dressing
SD# 39
Grooming
SD# 40
Bathing
41
Eating
42
Bed Mobility
43
Transferring
0
Health Plan ID
44
Walking
45
Behavior
46
Toileting
48
Clinical Monitoring
50
Current Case Mix
51
Orientation
52
Self Preservation
55
Hearing
56
Communication
57
Vision
58
Mental Status
60
Telephone Calling
61
Shopping
62
Meal Preparation
63
Light Housekeeping
64
Heavy Housekeeping
65
Laundry
66
Medication
68
Money Management
69
Transportation
67
Insulin Dependency
Wheeling
47
Special Treatment
49
Neuromuscular Diag.
Case Mix Last Assessment
74
Vent Dependent
Are you making a correction?
Get Client's Previous Data
0
Turn All Help on/off
Clear Cells by Group
no
0000
Last Case Mix value is from the PREVIOUS, not the current assessment
Authorize Rate As CL:T2030/T2030 TG
Exited/Failed to Enter CL Date Reason .
Authorize Type Valid
Dwelling License/Registration
Waiver Type
EW
Waiver Type Valid
no
Additional Required Information Delegate Agency
Case Manager's Phone# Case Manager's E-Mail Re-Type CM E-Mail
Optional Information Cc… Email Re-Type Cc… Email
Client's Legal Name: Legal Guardian: Print Client Name As: Print Case Mngr Name As: Print Provider Name As: Print Provider Address As:
Printed Notes:
Documentary Notes:
Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Confidential
2/26/2020 Not Valid for Rates or Plan
Page 1
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Individualized EW - Customized Living Plan
Ver. 11.1.9 DHS 02/11/2020 Client Last Name
Client First Name
0
0
Housing with Services Provider Name
PMI 0
Housing with Services - Street Address
County/Tribe
0
Housing with Services - City
Case Manager
0
Housing with Services - ZIP Code
Health Plan
0
Housing with Services - County
Recipient Health Plan ID 00000000000000000000 Start Date for CL Service Mental Status Evaluation Self Preservation
Housing with Services - HF ID # Assessment Date
1/0/1900
Assess. Effective Date
1/0/1900
1/0/1900 0 0
Community Budget Cap $
In CL Plan?
In CL to meet need?
Dependency Description
Need Documented ?
Score
-
Can get in and out of bed or chair without human help
no
no
Can move in bed without assistance
no
no
Select Housing Type
no
no
Enter the number of individuals sharing the space
no
no
0
Uses toilet w/o help
Transferring Dependency
43
0
Positioning Dependency
42
0
Active Behavioral Support Dependency
45
0
Behavior requires no intervention
Orientation Dependency
51
0
Oriented
48
0
66
0
Hearing
55
0
No hearing impairment
Vision
57
0
Has no vision impairment
Communication
56
0
Communicates needs
N/A
Select food prep facilities location
Month no
no
no
no
Less that once a day
Provider Meets Standards for EW 24 hr CL.
-
Name: Address: City: ZipCode: Taxonomy Code(if Applicable):
no
46
N/A
The following will be used to validate the NPI/UMPI:
no Toileting Dependency
Foster Care Monthly Rate Limit
no
CL/RC Monthly Rate Limit $
Independent
24 Hour Support Needed for: SD Ref
MDH Provider HFID Web Site
Individual Eligible for 24 Hr CL
24 Hr CL Monthly Rate Limit
Clinical Monitoring Dependency Med Admin + 50 hrs/mo of service
Bring in Client's Address
NPI/UMPI
Case Mix
Year
Please enter the Month and Year the Client first moved in, or will move in, to any Residential Services residence.
Sensory and Communication Status
Confidential
2/26/2020 Not Valid for Rates or Plan
Page 2
Light housekeeping
63
0
Heavy housekeeping
64
0
Laundry - personal
65
0
Laundry-linens
65
0
Shopping
61
0
In CL Plan?
Dependency Description
SD Ref
In CL to meet need?
Homemaking
Need Documen ted?
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
no
no
no
no
no
no
no
no
no
no
Service Description
Min/ Day
Min/ Week
Hrs/ Mo
Total Hours/ Month
Monthly Rate per Component
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
$
-
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
$
-
Sub-total home- making $
-
Food Preparation Service Description 62
Score 62
0
no
no
no
no
no no
Lunch prep and serve
62
0
Supper prep and serve
62
0
Snack prep and serve
62
0
no
Score
Supportive Services SD Ref Making appts
60
0
Arrange Non-medical Transportat
60
0
Money Mgt
68
0
Dependency Description
Hrs/ Mo
no
no
no
no
no
no
Total Hours/ Month
0.00 Service Description
no
Need Documen ted?
Breakfast prep and serve
Min/ Week
no
In CL Plan?
Food Preparation and Service
no
0
In CL to meet need?
Individual Assistance w Meal Prep in Own Apartment
Min/ Day
Service Description
Meals per Month
Min/ Day
Min/ Week
Hrs/ Mo
Total Monthly
Total Hours/ Month
Sub-total Meals $
-
Monthly Rate per Component
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
Socialization with given Ratio of Staff/Resident Socialization - Individual Group Socialization: 1 Staff to 25 Residents Group Socialization: 1 Staff to 6 12 Residents Group Socialization: 1 Staff to 13 - 20 Residents Group Socialization: 1 Staff to over 20 Residents
no no no no no Standardized Total Monthly Hours
Confidential
2/26/2020 Not Valid for Rates or Plan
Sub-total Supportive Services $
0.00
Page 3
-
Group Transportation: Group Transportation: riders Group Transportation: riders Group Transportation: riders
69 2 riders 3-5
69
Score
Dependency Description
0 0
69
0
69
0
6 - 10 Over 10 69
0
In CL Plan?
SD Ref
Driver 1:1 Non-medical Transportation
In CL to meet need?
Non-Medical Transportation
Need Docum ented?
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
no
no
no
no
no
no
no
no
no
no
Service Description
Mo
Total Hours/ Month
Monthly Rate per Component
0.00
$
-
0.00
$
-
0.00
$
-
0.00
$
-
0.00 Total Miles/Mo
$
-
1:1 mileage
69
0
N/A
N/A
0
no
0.00
$
-
Group Mileage 2 riders
69
0
N/A
N/A
0
no
0.00
$
-
Group Mileage 3 - 5 riders
69
0
N/A
N/A
0
no
0.00
$
-
Group Mileage 6 - 10 riders
69
0
N/A
N/A
0
no
0.00
$
-
Group Mileage over 10 riders
69
0
N/A
N/A
0
no
0.00
$
-
In CL Plan?
Miles Per Week
Hrs/ Mo
In CL to meet need?
Day
Min/ Week
Need Docume nted?
Mileage
Min/ Day
Personal Care
SD Ref
Score
Dressing
38
0
Grooming
39
0
Dependency Description Can dress w/o help of any kind Can comb hair, wash face, shave or brush their teeth w/o help of any kind
Bathing
40
0
Eating
41
Continence Care Walking Assistance With Use of Wheelchair
Service Description
Min/ Day
Min/ Week
Hrs/ Mo
Total Hours/ Month
no
no
no
0.00
$
-
Independent
no
no
0.00
$
-
0
Eats w/o help
no
no
0.00
$
-
46
0
Uses toilet w/o help
no
no
0.00
$
-
44
0
no
no
0.00
$
-
None
0
no
no
0.00
$
-
Transferring
43
0
no
no
0.00
$
-
Positioning
42
0
Walks w/o help Does not use wheelchair, or receives no personal help Can get in and out of bed or chair without human help Can move in bed without assistance
no
no
0.00
$
-
2/26/2020 Not Valid for Rates or Plan
$
-
Monthly Rate per Component
no
Confidential
Sub-total Nonmedical Transportation
Sub-total Personal Care $
Page 4
-
In CL Plan?
Dependency Description
In CL to meet need?
Other Delegated Health Services
Need Docume nted?
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
Min/ Day
Min/ Week
Hrs/ Mo
Total Hours/ Month
Monthly Rate per Component
SD Ref
Score
Med Administration or assistance with selfadministration
66
0
no
no
0.00
$
-
Verbal or Visual Medication Reminders Insulin Injections Therapeutic Exercises Delegated clinical monitoring Delegated nursing tasks
66 67 N/A 48 48
0 0 N/A 0 0
no no
no no no no no no no no no no
0.00 0.00 0.00 0.00
$ $ $ $ $ $ $ $ $ $
-
Less than once a day
no
Service Description
0.00 0.00 0.00 0.00 0.00 0.00
Score Med Set Ups and Monitoring Insulin Draws
66 67
Dependency Description
no no
0 0
In CL to meet need?
Medication Mgt by Licensed Nurse
Need Documen ted?
Other Delegated Total Monthly Hrs
Min/ Day
Service Description
Min/ Week
Hrs/ Mo
-
0.00
Total Hours/ Month
0.00 0.00
no no
Sub-total Other Delegated Health Services $
Monthly Rate per Component $ $
Sub-total Med Manage- ment $ -
-
Personal Security Awareness of need for assistance Will the person summon assistance when necessary?
Summoning Device
If yes, how will they summon help? What mechanism will they use? Is the mechanism included in the CL Rate?
$
-
$
If no, how will staff know when the person needs assistance? Self-Preservation Self-Preservation Score
0
Can the person evacuate in an emergency?
Independent
If no, what is the emergency plan?
Emergency Backup Planning Hospital Name
Hospital Phone
Physician Name
Physician Phone
Emergency Contact Name
ER Contact Phone
Emergency Contact Relationship If Client needs emergency medical or psychiatric services, call 911, admit to the Hospital listed, notify the emergency contact
ER Backup Plan Details listed, and if necessary, the listed physician. In addition:
Confidential
2/26/2020 Not Valid for Rates or Plan
Page 5
-
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Active Cognitive or Behavioral Support
Score
Implementation of written individual plan to address: 51 0 Wandering 51 0 Orientation issues 45 0 Anxiety 45 0 Verbal aggression 45 0 Physical aggression 45 0 Repetitive behavior 45 0 Agitation 45 0 Self-injurious behavior 45 0 Property destruction Other need related to mental health or cognitive challenge 0 0 0
Dependency Description
In CL Plan?
SD Ref
In CL to meet need?
Allowable Component Service
Need Documente d?
Does the recipient need service at additional times over and above those specified above to address needs specified in the table below? If yes, please specify the amount and type of service needed below.
Min/ Day
Service Description
Min/ Week
Hrs/ Mo
Total Hours/ Month
Monthly Rate per Component
no no no no no no no no no
no no no no no no no no no
0.00
$
-
0.00
$
-
no no
no no
0.00 0.00
$ $
-
no
no
0.00
$
-
Sub-total Active Cognitive or Behavioral Support $
-
0.00 Summary of Supervisory Support Frequency of contact. Indicate expected minimum as well as frequency at different times during the day/night. Mode of contact. Include description of how resident will request assistance or how staff will know when assistance is required. Competencies of Staff Providing Supervisory Support Training and Supervision of Staff Supervisory Support Scheduled Total CL Services (not final valid rate
$
Anticipated Days Absent Per Year? Go to new Prior Period Rate entry location Provider's equivalent non-public pay rate for these services if less than CL Rate --->
Confidential
2/26/2020 Not Valid for Rates or Plan
$0.00
Max Prior Rate is: N/A
You Must Select an Option --->
Page 6
-
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Projected Hours of CL Service by Component Type Per
Month Week Day
Home Management/Homemaking and Support Services:
0.00
0.00
0
Home Care Aide Services:
0.00
0.00
0
Home Health Aide Services:
0.00
0.00
0
Medication Setups by Licensed Nurse:
0.00
0.00
0
0.00
0 0.00
0.00
Total hours:
Total Hours For All Audited Services
EW - Customized Living Budget Recap at CL Start Date of 01/00/1900 CL Budget Recap Needs Start Date for CL Service to Proceed Monthly EW CL/24 CL Service $ Rate Limit Rate Proportion of EW Limit and Difference % & $$$
-
N/A
$
Proposed Customized Living Customized Living Rate with $ Adjustment for Days Absent
-
Individual Customized Living Customized Living Rate $ Limited to Private Pay Rate
-
Does temporary rate apply?
Full Rate*
Temporary Rate*
-
EW Community Budget $ Cap
-
$
-
Monthly Cost of Proposed $ Non CL EW Services
-
$
-
Amount of Proposed Monthly EW Budget including CL Rate
$
-
$
-
Monthly - Customized Living Rate
$
-
$
-
Daily CL Rate (For Information only)
$
-
$
-
$
-
Since Rate is withing $.50 of Limit, Rate has been Auto Rounded to exactly the Limit
no
Application of 50% difference $ to computed CL rate.
-
Temporary Rate - If applicable
Percent Transition Adjustment is of Final Rate
Warning! Prior Authorized rate and prior rate question are not consistent or either the Full Rate or the Prior Authorized rate is less than $25 . Please Verify
#DIV/0!
All monthly Service Rates are calculated based the Component Rates and Service Limits in effect on the Service Start Date. During the year this rate may change. After 09/30/2010 'Temporary' rates no longer apply. The 'Print Rate Guide' should be used to determine the Service Rate valid for payment during the authorization period. Use the rate that corresponds to the time period during which services will be provided and paid. In all cases, Providers are required to bill ONLY for the days of actual service. Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Confidential
2/26/2020 Not Valid for Rates or Plan
Page 7
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 EW - Customized Living and State Plan Home Care Services Authorized
DHS 02/11/2020
Ver. 11.1.9
EW Service Name Adult Day Care Adult Day Care FADS Adult Day Care Bath Family Caregiver Coaching/Counseling (plus assessment) Family Caregiver Training and Ed Family Caregiver Fam Memory Care Case Management Case Management Case Mgt - Paraprofessional CDCS Background Checks
Unit 15 minutes 15 minutes 15 minutes
15 minutes 15 minutes 15 minutes 15 minutes 15 minutes 15 minutes One print
CDCS Mandatory Case Mgt Chore Services Companion Services
15 minutes 15 minutes 15 minutes
CDCS Home Delivered Meal Home Health Aide Extended Homemaker Envir Accessibility Adapts -Home Install Envir Accessibility Adapts -Home Assess Envir Accessibility Adapts -Vehicle Install Envir Accessibility Adapts -Vehicle Assess Personal Care Assistant 1:1
Provider Name and Number
# of Units/ Month
Unit Rate
Totals $ $ $ -
Start Date
End Date
Up To Rate Limit as of 02/26/2020 $3.45 $3.45 $7.65
$ $ $ $ $ $
-
$
-
Per Service 1Meal/Day 15 minutes 15 minutes Per Waiver Yr
$ $ $
-
$
-
Per Assess Per Waiver Yr
$
-
$
-
Per Assess 15 minutes
$ $
-
$18.11 $18.11 $18.11 $25.46 $25.46 $9.39 $25.00 Up to Required Case MGT Cap Amount $4.15 $2.57 Up to CDCS Cap Case Mix Cap $7.06 $8.01 $4.84 EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 $4.45
Personal Care Assistant - Shared 1:2 15 minutes
$
-
$3.34
Personal Care Assistant - Shared 1:3 LPN Complex Extended LPN Regular Extended LPN shared 1:2 Extended RN Complex Extended RN Regular Extended RN shared 1:2 Extended
15 minutes 15 minutes 15 minutes 15 minutes 15 minutes 15 minutes 15 minutes
$ $ $ $ $ $ $
-
Respite Certified Facility Respite, Hospital Respite, In-home Respite, In-home Respite, Out of home Respite, Out of home Supplies and Equipment Supplies and Equipment Supplies and Equipment Supplies and Equipment Supplies and Equipment Transitional Services Transportation Transportation, Non-commercial
Per Diem Per Diem 15 minutes Per Diem 15 minutes Per Diem Total/Month Total/Month Total/Month Total/Month Total/Month Per Occurs 1-way trip Per Mile
$ $ $ $ $ $ $ $
-
$2.93 $7.84 $6.69 $5.02 $10.44 $8.71 $6.53 NF's Per diem for the Recipient's case mix $147.85 $5.77 $103.85 $5.77 $103.85 Up to Budget Cap Up to Budget Cap Up to Budget Cap Up to Budget Cap Up to Budget Cap Up to Budget Cap $20.21 $0.58
Total All EW Excluding CL Services
From 02/26/2020 $ -
CL Services Rate Summary by Effective Date Customized Living Services
Monthly
1
Estimated monthly total for proposed EW Services including CL Services
From 01/00/1900
From 10/01/2010
$
-
$
$
-
CL End Date
-
Client: PMI: Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Confidential
2/26/2020 Not Valid for Rates or Plan
Page 8
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Request Approval to Exceed the CL Service Limit and/or the EW Case-mix Budget Cap Applies to All Residential Services Clients Clients leaving a Nursing Facility (NF) where they resided more than 30 days may qualify for a higher Community Case-mix EW Budget Cap (Conversion Budget Cap). Once established, this budget may be used for any combination of Residential Services. This means the client may exceed the standard RS Service Case–mix Rate Limits (CL or RC Limit). Once established, the Conversion Budget Cap may only increase by COLAs or legislative mandated. The Conversion Budget Cap coincides with the Waiver Span and must be reviewed each time the client is re-assessed. If the Conversion Budget Cap is reduced at re-assessment, this reduced value becomes the new Conversion Budget Cap. Complete this page for all clients exceeding the Community Casemix EW Budget Cap. A Conversion Budget Cap may never exceed the discharge NF Medicaid equivalent monthly rate, less the Maintenance Needs Allowance (MNA); or a lower amount approved at time of discharge. Any Conversion Budget Cap must be approved prior to authorization for payment. You may optionally set a Budget RS Limit for service planning which will be enforced. This Budget RS Limit may be changed at any time, but the total of all services may never exceed the Conversion Budget Cap. If the Conversion Budget Cap is new, begin by providing the NF daily rate. Next complete the CL Plan with necessary services and times. If the Error Report indicates the RS service limit or the EW Community Budget Cap is exceeded, return here to complete this form and request a Conversion Budget Cap. If the application is for a renewal and last year’s Conversion Budget Cap is blank, enter the largest Conversion Budget Cap approved in the past. Use last year’s value if that is all that is known. (This is imported from version 8.1.1 or later CL Tools.) If services will be paid by a Health Plan, follow their process for getting or reauthorizing the higher limits. Except for South County, use the ‘Validate Plan Approval’ button to approve the CL Tool for submission to DHS. Provide the Health Plan approved Conversion Budget Cap and the Budget CL Limit if given. If the entered limits are exceeded, you will need to adjust the RS Tool to stay within limits. Submit the RS Plan as usual. Once any submission errors have been corrected, the higher rate may be authorized. If the limits are to be approved by DHS, complete this page. You must complete the EW Services Authorized page in the Tool. You should provide justification for all RS services on the Audit Report, especially those indicating a warning. Once complete, submit the RS Tool in the standard way. There may be other documentation required beyond this RS Tool. Submit as you have in the past. The approved limits will be entered into the RS Tool and the Tool returned to you. If the approved limits are less than the rates developed, you will need to adjust the RS Tool to get the rates below the limits. Finally, verify the approved rate on the Error Report and re-submit the RS Plan for final acceptance.
Enter the NF Daily Rate at discharge
Current maximum combined CL and EW Services authorized Conversion Budget Cap
-$1,003.00
Date of Discharge
Maximum Non- CL EW Services to Authorize
-$1,003.00
Conversion Limit is Authorized
FALSE
Actual Non- CL Services Authorized
$0.00
Maximum CL Services to Authorize
-$1,003.00
Actual CL Services Authorized
$0.00
Total of all Authorized Services
$0.00
CL Services or Non- CL Services Over Maximum
$1,003.00
Community Case-mix EW Budget Cap (Conversion Budget Cap) Request Section Is Client making a new request to exceed the Case-mix Budget Cap?
Planned CL Rate is below the normal CL Limits for this Case Mix
`
CL Rate + EW Services are below the normal Budget Cap for this Case Mix
Is Client requesting an annual review to renew a previously approved Conversion Limit that exceeds the Case-mix Budget Cap?
Original approved Conversion EW Services Case-Mix Budget Cap limit
DHS Approval Required?
N/A
Health Plan Approval Required?
N/A
DHS Approved?
N/A
Health Plan Approval Status
no
DHS Approved CL Rate
N/A
Health Plan Approved CL Rate
N/A
Do Not Approve
DHS Approved EW Cap Submit to DHS along with other necessary documentation documentation for approval
Most Recent Health Plan Approved EW Cap
N/A
N/A
DHS Use Only Validate Plan
Confidential
2/26/2020 Not Valid for Rates or Plan
Page 9
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
Monthly Rate Guide Printed February 26, 2020 DHS 02/11/2020
Ver. 11.1.9
EW - Customized Living Services Rate Summary by Effective Date Monthly Rate
Daily Rate $
Full monthly CL Rate on: ############# Max Prior Rate is $N/A
First month Current Rates
Prior Period Rate Start Date
From Date
To Date
2/1/2020
#############
Current Period Portion
1/0/1900
1/0/1900
Total Rate For First Month
1/0/1900
1/0/1900
Prior Period Portion
-
Authorize Rate
$0.00 $0.00 $
$0.00 Monthly $ ‐
-
$
-
Monthly
This is the CL Service Rate valid for payment during the authorization period. In all cases, Providers are required to bill ONLY for the days of actual service.
Client: Provider Name:
PMI:
Provider NPI: 0 Housing with Services Establishment Address: County/Tribe: Case Manager:
,MN Health Plan:
0
Recipient Health Plan ID: 0
0
Date: Rate Guide was Mailed/Given On:
Note: Monthly and Daily ratesRates shown here. You must authorize the monthly rate shown on this Rate Guide. In all cases, Providers are required to bill ONLY for the days of actual service. You may notice that the rates shown here may be a few cents different than the rate calculated taking an old tool's rate and multiplying by the COLA factor. This is due to rounding issues with the component rates. If slightly different rates are shown here, they are correct and may be authorized.
Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Page 17 of 34 Valid for Rate
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 VII. Budget Worksheet
DHS 02/11/2020
Ver. 11.1.9
Client: PMI: Service Adult Day Care Adult Day Care FADS Adult Day Care Bath Family Caregiver Coaching/Counseling (plus assessment)
Unit
Provider Name and Number
Start Date
End Date
# of Units/ Month
15 minutes 15 minutes 15 minutes 15 minutes
15 minutes Family Caregiver Training and Ed 15 minutes Family Caregiver Fam Memory Care 15 minutes Case Management 15 minutes Case Management 15 minutes Case Mgt - Paraprofessional Monthly Customized Living Services (planned for a month of service) 15 minutes Companion Services 15 minutes Home Health Aide Extended Visit Home Health Telehomecare Per Waiver Yr Envir Accessibility Adapts -Home Install Per Waiver Yr Envir Accessibility Adapts -Vehicle Install Per Assess Envir Accessibility Adapts -Vehicle Assess 15 minutes Personal Care Assistant - RN Supervision 15 minutes Personal Care Assistant 1:1 15 minutes Personal Care Assistant - Shared 1:2 15 minutes Personal Care Assistant - Shared 1:3 15 minutes LPN Complex Extended 15 minutes LPN Regular Extended 15 minutes LPN shared 1:2 Extended 15 minutes RN Complex Extended 15 minutes RN Regular Extended 15 minutes RN shared 1:2 Extended Total/Month Supplies and Equipment Total/Month Supplies and Equipment Total/Month Supplies and Equipment Total/Month Supplies and Equipment Total/Month Supplies and Equipment Per Occurs Transitional Services 1-way trip Transportation Per Mile Transportation, Non-commercial Notice: Any First Month Rate is subject to change once this RS Tool is submitted if the Prior Rate on file does not match the Prior Rate provided in this RS Tool.
Page 18 of 34 Valid for Rate and Plan
1
Unit Rate $ $ $ $ -
Cost Per Month $ $ $ $ -
$ $ $ $ $ $
$ $ $ $ $ $
-
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
-
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
-
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Total Cost Per Month From October 01, 2010 IX. Choosing Community Long Term Care
$
-
In all cases Providers are required to bill ONLY for the days of actual service Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
You can choose to receive services in the community (your home) or in a nursing facility. Were you offered this choice? You can choose the provider you prefer for services. Did the person who helped you with this plan give you a list of providers, or tell you about different providers that you could choose for services in the plan? Did you have the chance to help develop this plan, including the kinds of services you want to receive? After reading the plan, do you agree with the services, and providers, as written? You have the right to apply for Minnesota Health Care Programs (MHCP) that may help pay for services planned here, including programs such as the Elderly Waiver Program, and the Alternative Care Program. Do you wish to apply for Minnesota Health Care Programs? Client signature:
Date
Date
Signature of Person Completing this Plan
Printed: February 26, 2020
Date
Date
Yes Application for MHCP Submitted?
Support Plan was Mailed/Given On: Note: A copy of the RS Plan must be attached to the CSSP and must be provided to the Client for this to constitute a complete plan. Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Page 19 of 34 Valid for Rate and Plan
No
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Individualized EW - Customized Living Customized Living Plan
DHS 02/11/2020
Client
Ver 11.1.9
Home Care Provider Name
PMI
Provider NPI 0 Housing with Services Address
County/Tribes
0
Health Plan 0
0
Case Manager
Primary Diagnosis 00000000
Case Manager Phone# -
, MN
Recipient 0
Case Manager Email Start Date for CL 1/0/1900
In CL Plan?
Score
Light housekeeping Heavy housekeeping
no no
N/A N/A
Total Hours/ Month 0.00 0.00
Laundry - personal
no
N/A
0.00
Laundry-linens
no
N/A
0.00
Shopping
no
N/A
0.00
In CL Plan?
Score
no
N/A
In CL Plan?
Score
Homemaking
Estimation of Time for Purposes of Rate Computation
HwS Consultation Verif. Code
Breakfast prep and serve
no
N/A
0.00
Lunch prep and serve
no
N/A
0.00
Supper prep and serve
no
N/A
0.00
Snack prep and serve
no
N/A
0.00
Food Preparation
Individual Assistance w Meal Prep in Own Apartment
Food Preparation and Service
Service Description
Client
Client
Service Description
Total Hours/ Month 0.00
Service Description
Client
Page 20 of 34 Valid for Rate and Plan
# of Meals/ Snacks Month
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
In CL Plan?
Score
Making appts
no
N/A
0.00
Arrange Non-medical Transportation
no
N/A
0.00
Money Mgt
no
N/A
0.00
Socialization - Individual
no
N/A
0.00
Group Socialization: 1 Staff to 25 Residents
no
N/A
0.00
Group Socialization: 1 Staff to 6 12 Residents
no
N/A
0.00
Group Socialization: 1 Staff to 13 20 Residents
no
N/A
0.00
Group Socialization: 1 Staff to over 20 Residents
no
N/A
0.00
In CL Plan?
Score
Driver 1:1 Non-medical Transportation
no
N/A
0.00
Group Transportation: 2 riders
no
N/A
0.00
Group Transportation: 3 - 5 riders
no
N/A
0.00
Group Transportation: 6 - 10 riders
no
N/A
0.00
Group Transportation: Over 10 riders
no
N/A
0.00
In CL Plan?
Score
Supportive Services
Non-Medical Transportation
Mileage
1:1 mileage Group Mileage 2 riders Group Mileage 3 - 5 riders Group Mileage 6 - 10 riders Group Mileage over 10 riders
no no no no no
Service Description
Client
Service Description
Client
Service Description
Client
Total Hours/ Month
Total Hours/ Month
Total Hours/ Month
N/A
0.00
N/A
0.00
N/A
0.00
N/A
0.00
N/A
0.00
Page 21 of 34 Valid for Rate and Plan
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
In CL Plan?
Score
Dressing
no
N/A
Grooming
no
N/A
Bathing
no
N/A
0.00
Eating
no
N/A
0.00
Continence Care
no
N/A
0.00
Walking
no
N/A
0.00
Assistance With Use of Wheelchair
no
N/A
0.00
Transferring
no
N/A
0.00
Positioning
no
N/A
0.00
In CL Plan?
Score
Personal Care
Med Administration or assistance with self-administration
no
N/A
0.00
Verbal or Visual Medication Reminders
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
no
N/A
0.00
Other Delegated Health Services
Insulin Injections Therapeutic Exercises Delegated clinical monitoring Delegated nursing tasks
Service Description
Client
Total Hours/ Month 0.00
Service Description
Client
Page 22 of 34 Valid for Rate and Plan
Total Hours/ Month
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
In CL Plan?
Score
Medication Mgt by Licensed Nurse
Med Set Ups and Monitoring
no
N/A
0.00
Insulin Draws
no
N/A
0.00
In CL Plan?
Score
Sensory and Communication Status Hearing
N/A
0
Vision
N/A
0
Communication
N/A
0
Service Description
Total Hours/ Month
Client
Service Description
Client
Personal Security
Client
Awareness of need for assistance Will the person summon assistance when necessary?
If yes, how will they summon help?
0
What mechanism will they use?
no no
0
no If no, how will staff know when the person needs assistance?
Self-Preservation Can the person evacuate in an emergency?
0
If no, what is the emergency plan?
Emergency Backup Planning Hospital Name Physician Name Emergency Contact Name
Hospital Phone Physician Phone ER Contact Phone
Emergency Contact Relationship ER Backup Plan Details
If Client needs emergency medical or psychiatric services, call 911, admit to the Hospital listed, notify the emergency contact listed, and if necessary, the listed physician. In addition:
Page 23 of 34 Valid for Rate and Plan
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020 Active Cognitive or Behavioral Support
In CL Plan?
Score
Implementation of written individual plan to address:
no
N/A
no
N/A
no
N/A
no
N/A
no
N/A
no
N/A
no
N/A
no
N/A
no
N/A
:
no
N/A
0.00
:
no
N/A
0.00
:
no
N/A
0.00
Wandering: Orientation issues : Anxiety: Verbal aggression: Physical aggression: Repetitive behavior: Agitation: Self-injurious behavior: Property destruction:
Service Description
Client
Total Hours/ Month 0.00
0.00
Summary of Supervisory Support Service Description
Client
Frequency of contact. Indicate expected minimum as well as frequency at different times during the day/night.
Mode of contact : Include description of how resident will summon assistance or how staff will know when assistance is required.
Competencies of Staff Implementing Active Cognitive and/or Behavioral Support
Training and Supervision of Staff Implementing Active Cognitive and/or Behavioral Support
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Summary of Estimated Monthly Hours of Service Column1 By Type
24 Hour Support Needed for: Toileting Dependency
no
Transferring Dependency
no
Positioning Dependency
no
Active Behavioral Support Dependency
no
Orientation Dependency
no
Clinical Monitoring Dependency
no
Med Admin + 50 hrs/mo of service
no
Column2
Column3 Per Month
Per Week
$
-
$
-
$
-
Home Care Aide Services:
$
-
$
-
$
-
Home Health Aide Services: Medication Setups by Licensed Nurse: Estimated combined hours of customized living services:
$ $
-
$ $
-
$ $
-
$
-
$
-
$
-
Notice: Any First Month Rate is subject to change once this RS Tool is submitted if the Prior Rate on file does not match the Prior Rate provided in this RS Tool.
Cost of Customized Living Services per mo.
From 01/00/00 To 01/00/00
End Date
$
1/0/1900
-
Monthly Cost of Non- CL EW Services
$
-
In all cases, Providers are required to bill based on the amounts in the Rate Guide and ONLY for the days of actual service provided. Client Notes
Printed: February 26, 2020
Per Day
Home Management / Homemaking and Support Services:
Date
Customized Living Plan was Mailed/Given On:
Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Page 25 of 34 Valid for Rate and Plan
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
DHS 02/11/2020 Ver. 11.1.9
EW Residential Monthly Services Rate Limits Service Limit Effective Dates:
Case Mix A B C D E F G H I J K L L* V
Community Budget Cap as of $3,457 $3,931 $4,614 $4,763 $5,255 $5,415 $5,587 $6,302 $6,469 $6,897 $8,036 $3,457 $2,662 $29,237 Based on Assessment Change Date
24 Hr CL Rate Limit $2,872 $3,315 $3,899 $4,070 $4,528 $4,696 $4,884 $5,486 $5,640 $6,032 $7,046 $2,872 N/A $25,625
Wednesday, January 01, 2020
Customized Living (Not 24 Hr) Rate Limits Statewide $1,543 $1,754 $2,058 $2,261 $2,347 $2,420 $2,497 $2,815 $2,903 $3,080 $3,592 $1,543 $1,158 $13,871
Group 1 Group 2 $1,412 $1,446 $1,563 $1,612 $1,780 $1,865 $1,918 $1,967 $2,084 $2,122 $2,168 $2,168 $2,250 $2,305 $2,524 $2,571 $2,594 $2,664 $2,733 $2,804 $3,166 $3,199 $1,412 $1,446 $1,058 $1,086 $11,934 $12,231 Based on CL Start Date
Group 3 $1,683 $1,850 $2,222 $2,347 $2,566 $2,607 $2,746 $3,100 $3,184 $3,410 $3,890 $1,683 $1,263 $14,462
New/Assessed > 08/31/11 New/Assessed > 06/30/13
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EW Residential Daily Services Rate Limits
Case Mix A B C D E F G H I J K L L* V
Wednesday, January 01, 2020 y Service Limit Effective Dates: Budget Cap 24 Hr CL Customized Living (Not 24 Hr) Rate Limits as of Rate Limit 02/26/2020 Statewide Group 1 Group 2 Group 3 $113.58 $94.36 $50.69 $46.39 $47.51 $55.29 $129.15 $108.91 $57.63 $51.35 $52.96 $60.78 $151.59 $128.10 $67.61 $58.48 $61.27 $73.00 $156.48 $133.72 $74.28 $63.01 $64.62 $77.11 $172.65 $148.76 $77.11 $68.47 $69.72 $84.30 $177.91 $154.28 $79.51 $71.23 $71.23 $85.65 $183.56 $160.46 $82.04 $73.92 $75.73 $90.22 $207.05 $180.24 $92.48 $82.92 $84.47 $101.85 $212.53 $185.30 $95.38 $85.22 $87.52 $104.61 $226.60 $198.18 $101.19 $89.79 $92.12 $112.03 $264.02 $231.49 $118.01 $104.02 $105.10 $127.80 $113.58 $94.36 $50.69 $46.39 $47.51 $55.29 $87.46 N/A $38.05 $34.76 $35.68 $41.49 $960.56 $841.89 $455.72 $392.08 $401.84 $475.14 Based on Based on CL Start Date Assessment Change Date
New/Assessed > 08/31/11 New/Assessed > 06/30/13
Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
Service Component Rates DHS 02/11/2020 Effective Date
Service Category
January 1, 2020
Ver. 11.1.9
Hourly Unit
Home Management/Homemaking and Support Services
$17.8400
Home Care Aide Services including Active Behavioral Support.
$23.7200
Home Health Care Aide Services/Delegated Nursing Services
$27.0400
Medication Setups by Licensed Nurse
$33.9700
Mileage rate
Per Mile $0.5200
Summoning Device
$29.0000
Breakfast
$3.6700
Lunch
$4.5700
Supper
$4.5700
Snack
$0.4500 Socialization Hourly Rate $5.1000
Shared Services Socialization 1 Staff to 2-5 Residents Socialization 1 Staff to 6 - 12 Residents
$1.9900
Socialization 1 Staff to 13 - 20 Residents
$1.0900
Socialization 1 Staff to over 20 Residents
$0.5900 Driver Hourly Rate $8.9200
/Month
Group Mileage Rate $0.2700
Group Transportation
# of Riders 2
Group Transportation
# of Riders 3 - 5
$4.4600
$0.1300
Group Transportation
# of Riders 6 - 10
$2.2400
$0.0800
Group Transportation
# of Riders - More than 10
$1.1900
$0.0400
Copyright © 2009 - 2020 Minnesota Department of Human Services (DHS). All Rights Reserved
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
DHS 02/11/2020
EW Service Name
Unit Adult Day Care 15 minutes Adult Day Care FADS 15 minutes Adult Day Care Daily Adult Day Care FADS Daily Adult Day Care Bath 15 minutes Caregiver Training and Ed 15 minutes Family Caregiver Coaching/Counseling (plus asses15 minutes Family Caregiver Training and Ed 15 minutes Family Caregiver Fam Memory Care 15 minutes Case Management 15 minutes Case Mgt - Paraprofessional 15 minutes CDCS Background Checks One print CDCS Mandatory Case Mgt 15 minutes Chore Services 15 minutes Companion Services 15 minutes CDCS Per Service Customized Living Services (planned for a month oMonthly Home Delivered Meal 1Meal/Day Home Health Aide Visit Home Health Aide Extended 15 minutes Home Health - Skilled Nursing Visit Home Health Telehomecare Visit Homemaker 15 minutes Homemaker Per Diem Per Waiver Yr Envir Accessibility Adapts -Home Install Per Assess Envir Accessibility Adapts -Home Assess Per Waiver Yr Envir Accessibility Adapts -Vehicle Install Per Assess Envir Accessibility Adapts -Vehicle Assess Personal Care Assistant - RN Supervision 15 minutes Personal Care Assistant 1:1 15 minutes Personal Care Assistant - Shared 1:2 15 minutes Personal Care Assistant - Shared 1:3 15 minutes LPN Complex Extended 15 minutes LPN Regular Extended 15 minutes LPN shared 1:2 Extended 15 minutes RN Complex Extended 15 minutes RN Regular Extended 15 minutes RN shared 1:2 Extended 15 minutes Respite Certified Facility Per Diem Per Diem Respite, Hospital Respite, In-home 15 minutes Respite, In-home Per Diem Respite, Out of home 15 minutes Respite, Out of home Per Diem Supplies and Equipment Total/Month Transitional Services Per Occurs Transportation 1-way trip Transportation, Non-commercial Per Mile
EW Service Information Proc Code S5100 S5100 S5102 S5102 S5100 S5116 S5115 S5115 S5115 T1016 T1016 T2040 T2041 S5120 S5135 T2028 T2030/ S5170 T1021 T1004 T1030 T1030 S5130 S5131 S5165 T1028 T2039 T2039 T1019 T1019 T1019 T1019 T1003 T1003 T1003 T1002 T1002 T1002 H0045 H0045 S5150 S5151 S5150 H0045 T2029 T2038 T2003 S0215
Mod Mod 1 2 U7 U7 TF TF TG UC TF
GT
UD UA UC TT HQ TG UC TT TG UC TT
UB
UC UC
Up To Rate Limit as of 02/26/2020 $ 3.45 $ 3.45 N/A N/A $ 7.65 N/A $ 18.11 $ 18.11 $ 18.11 $ 25.46 UC $ 9.39 $ 25.00 Up to Required Case MGT C $ 4.15 $ 2.57 Up to CDCS Cap Case Mix C See CL Service Limits $ 7.06 N/A $ 8.01 N/A N/A $ 4.84 N/A EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 EAA Services <= $20,0000 N/A $ 4.45 UC $ 3.34 UC $ 2.93 UC $ 7.84 0 $ 6.69 UC $ 5.02 UC $ 10.44 $ 8.71 UC $ 6.53 NF's Per diem for the Recipie $ 147.85 $ 5.77 $ 103.85 $ 5.77 $ 103.85 Up to Budget Cap Up to Budget Cap $ 20.21 $ 0.58
Selected Pages from EW Residential Services - Workbook - Version 11.1.9 (XLSM) – Released 2/11/2020
Estimated Hours of CL Services per Month
Ver. 11.1.9
DHS 02/11/2020 Client PMI 00000000
HM/SS Tasks housekeeping
RS Plan Form Ref 40
laundry
43
shopping
44
indiv meal prep
47
making appointments
55
arranging transportation
56
money management
57
congregate breakfast
49
congregate lunch
50
congregate supper
51
congregate snack
52
socialization
59-63
transportation
67-71
Confidential
Rate
Total Hours
Hours/Mo
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Home Health Aide-Like Tasks eating
RS Plan Form Ref Hours/Mo 84 0.00
continence care
85
walking
86
transferring
88
positioning
89
medication administration
92
insulin injections
94
therapeutic exercises
95
delegated clinical monitoring
96
other delegated tasks
97
other delegated tasks
98
other delegated tasks
99
other delegated tasks
100
other delegated tasks
101
other delegated tasks
102
2/26/2020 Not Valid for Rates or Plan
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
HM/SS
0.00
$17.84
HCA
0.00
$23.72
HHA Med Setup
0.00 0.00
$27.04 $33.97
Total Hrs
0.00
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Home Care Tasks dressing, bathing and gro wheeling
RS Plan Form Ref 81-83 87
medication reminders 93 Active Behavioral or Cognitive Support Wandering 129 Orientation issues 130 Anxiety
131
Verbal aggression
132
Physical aggression
133
Repetitive behavior
134
Agitation
135
Self-injurious behavior
136
Property destruction
137
Other
139
Other
140
Other
141
Confidential
0.00
Home health aide-like hours/month: Med setups by licensed nurse Ref
Hours/Mo
Med set ups
105
0.00 0.00 0.00
Insulin draws
106
Med setup hours/month:
0.00 Hrs/Mo
0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2/26/2020 Not Valid for Rates or Plan
Page 34
2021 NURSE MANAGERS’ EDUCATION SERIES
2019 Updates to Comprehensive Home Care Statutes The 2019 Minnesota legislature passed several “tweaks” to the comprehensive home care statutes. Most of the changes were made to improve the functionality of home care regulations. All these changes except one (noted below) go into effect on August 1, 2019. They then will be carried over and applied to the Assisted Living Licensure law that goes into effect on August 1, 2021. The new language affects 28 areas of home care regulations: 1. The definition of Medication Administration has been revised. The new definition is: "Medication administration" means performing a set of tasks to ensure a client takes medications, and includes that include the following: i. checking the client's medication record; ii. preparing the medication as necessary; iii. administering the medication to the client; iv. documenting the administration or reason for not administering the medication; and v. reporting to a registered nurse or appropriate licensed health professional any concerns about the medication, the client, or the client's refusal to take the medication. Implication: Verify your policy and procedure include this new definition. 2. There is a new definition of Medication Reconciliation: "Medication reconciliation" means the process of identifying the most accurate list of all medications the client is taking, including the name, dosage, frequency, and route by comparing the client record to an external list of medications obtained from the client, hospital, prescriber, or other provider. Implication: Create a Medication Reconciliation policy that includes this new definition. Medication Reconciliation is a new step required as part of any medication management that is conducted (see #20). 3. The definition of Standby Assistance has been modified: "Standby assistance" means the presence of another person within arm's reach to minimize the risk of injury while performing daily activities through physical intervention or cuing to assist a client with an assistive task by providing cues, oversight, and minimal physical assistance. Implication: Modify your definition of standby assistance that is included in any policy or procedure. This change will help Basic Home Care licenses to continue caring for certain clients who would fall under this expanded definition. 4. Clarification that an approved Change of Ownership (CHOW) results in the receipt of a full home care license, not a temporary home care license (unless the selling entity only had a temporary license at the time of the CHOW). Implication: None – this is what has been occurring but was not clear in current language. 5. Clarification that when a CHOW occurs, the new owner can treat the employees acquired as if nothing had changed, in respect to orientation, training, tuberculosis testing, background
studies, and competency testing and training on applicable home care policies, except for policies that differ from the prior license owner. Changes in policy must be trained and tested within 90 days after the date of the change in ownership. In other words, a CHOW includes the employee records such records are considered current for the new owner. Implication: None – This is what has been occurring but representatives from MDH gave varying answers at times, so we memorialized the correct answer in the update statute. 6. A new fine of $1,000 will be assessed if a temporary home care licensee fails to notify MDH within 5 days after they begin providing home care services to their first client. This is effective May 31, 2019. Implication: If you start a new home care agency, and you fail to inform MDH within 5 days after admitting your first home care client, you can expect to receive a $1,000 fine from MDH. The notification requirement is the same, but the fine is new. NOTE – in effect on 5-31-19. 7. Permits temporary licenses to be extended beyond one year under certain circumstances. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This permits MDH to extend the temporary license if a reconsideration is filed, conditions are applied, or other actions are taken. 8. Permits MDH to extend temporary licenses with conditions for up to 90 days when substantial compliance is not determined on the temporary license survey. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This permits MDH to extend the temporary license if a reconsideration is filed, conditions are applied, or other actions are taken. 9. Allows temporary licenses to submit reconsideration requests regarding licensing orders identified on the temporary license survey. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This allows providers caught in that situation to request a reconsideration of the survey findings. 10. Clarifies that when a temporary license has their “full” license denied, they are permitted to continue operating as a home care provider when (1) a reconsideration request is in process, (2) an extension of the temporary licenses is being negotiated, (3) the placement of conditions on the temporary license are being negotiated, or (4) the transfer of home care clients from the temporary license to a new home care provider is in progress. Implication: Current language gave MDH few options if they determined that substantial compliance did not exist at the time of the initial survey. This permits MDH to extend the temporary license if a reconsideration is filed, conditions are applied, or other actions are taken.
It also permits the provider to continue operating if the license has been revoked while clients are being moved or a new home care licensee is being brought in to take over the service plans. 11. Requires that MDH conduct a full home care survey within six months after the issuance of a new license resulting from a change of ownership (CHOW). Implication: Current language did not require any survey after a CHOW was executed. MDH had enough examples of sales resulting in substantial decreases in regulatory compliance that this language was added. 12. Clarifies that when a home care license has conditions applied to the license, or the license is being suspended or revoked, the licensee may continue operating during the period home care clients are being transferred to other providers. Implication: Permits continuity of care during these situations. 13. Requires that TB screening results are included in employee records. Implication: Providers may have these records in separate employee medical/health files. Surveyors are permitted to review for TB compliance but are not permitted to request employee medical or health files. 14. Throughout the home care regulations, replaces terms such as “initiation of” with “date that services are first provided to the client”. Examples include: notice of the bill of rights, statement of home care services, 30-day time limit to conduct supervision of new staff (after first performing delegated tasks for clients), 5 and 14-day deadlines for assessments, 14-day deadline for finalization of a written service plan, etc. Implication: None. This has been the communicated position of MDH, but at times surveyors were confused and tried to apply the date admission agreements were signed as the trigger for counting days. 15. Clarifies that if home care services are provided to a client prior to an assessment conducted by an RN, an RN must complete a temporary plan and orientate staff assigned to deliver the services identified in the temporary plan. Implication: None. This was not address in current statutes but has been the expectation of both providers and regulators. 16. Makes the following changes to elements required to be in the written service plan: Replaces: “the frequency of sessions of supervision of staff and type of personnel who will supervise staff” with “the schedule and methods of monitoring staff providing home care services”. The concept is the same, but the language is clearer.
Implication: You may need to change your policy and procedure, and possibly the description on your service plan. Provides additional clarify of what is required. 17. Eliminates the requirement to include “identification of and information as to who has authority to sign for the client in an emergency.” Note – The service plan must still include “names and contact information of persons the client wishes to have notified in an emergency or if there is a significant adverse change in the client's condition.” Implication: Current language was very confusing and resulted in a significant number of correction orders during surveys. Therefore, the requirement was eliminated. Policies and procedures may need to be updated, as well as the format for service plans. 18. Clarifies that the requirement for the comprehensive home care provider to identify how it will ensure security and accountability for the overall management, control, and disposition of medications in compliance with state and federal regulations applies only to those medications that are being managed, stored, and secured by the comprehensive home care provider. Implication: Clarifies that this requirement only applies to those medications you have accepted responsibility for. 19. Adds a requirement that the comprehensive home care provider provide instructions to the client or client's representative on interventions to manage the client's medications and prevent diversion of medications. Implication: Documentation on the medication assessment or medication administration form, or similar, will need to indicate that you communicated to the client/family how controlled substances will be stored to prevent diversion. 20. Adds a requirement that for each client receiving medication management services from a comprehensive home care provider, a medication reconciliation must be completed when a licensed nurse, licensed health professional, or authorized prescriber is providing medication management. Implication: Policy and procedures for medication management services will need to be modified to include medication reconciliation (see definition in #2). Nurses will need to be trained on conducting and documenting medication reconciliation. 21. Expands the timeframe to provide medications for clients who will be away from home from 120 hours to seven calendar days. Implication: Extends the time from 5 days to 7 days. Uses days instead of hours for clarity. Policy and procedures will need to be updated.
22. Adds a new requirement for clients who will be away from home. The policy and procedure must now include how the unlicensed staff must document in the client's record any unused medications that are returned to the provider, including the name of each medication and the doses of each returned medication. Implication: You will need to update your policy and procedures. This was an identified weakness in current regulations. 23. Clarifies that treatment and therapy orders must be renewed every 12 months. Implication: You will need to update your policy and procedures. This was an identified weakness in current regulations. 24. Clarifies that orientation of new staff to the provider's policies and procedures related to the provision of home care services is limited to those policies and procedures that are applicable to the new staff person. No need to train in areas outside the scope of the new employees’ position! Implications: Clarifies the obvious. No need to train on policies and procedures that are not applicable to a new employee. 25. Creates a new section (144A.4798) titled Disease Prevention and Infection Control. This new section bundles the following topics that were previously spread out within the home care statues: i. TB infection control program ii. Reporting of communicable diseases iii. Establishing and maintaining an effective infection control program Implication: Consider creating a new Disease Prevention and Infection control binder that has all the applicable policies and procedures in it. None of the three elements are new – they are now being bundled together for clarify and accuracy of survey reports. 26. Clarifies that public members of the Home Care and Assisted Living Program Advisory Council may include persons who have received home care services within five years of the application date. Implication: Expands the scope of who can be a member of this advisory council. 27. Deletes the transition period for establishing integrated licenses (the period ended June 30, 2015). Implication: This transition period has expired, so we removed it from the statutes.
28. Deletes the home care license transition period that was in place between October 1, 2013 and June 30, 2015. Implication: This transition period has expired, so we removed it from the statutes.
2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION
SENIORS AT THE CENTER OF THE
SOLUTIONS SAFETY
Seniors and their families should have confidence in the care they receive and the laws in place to protect older & vulnerable adults.
CHOICE
Seniors should be able to choose settings that promote independence and best meet their needs, interests, and lifestyles.
ACCESS
Seniors need access to senior services in all places they call home to remain connected to family and community.
GOALS
Together, with a broad coalition of consumer advocates, regulators, and senior living providers, we have worked to develop solutions that will lead to great TRANSPARENCY, ACCOUNTABILITY, AND CONFIDENCE THAT SENIORS ARE RECEIVING SAFE, QUALITY CARE.
WHAT’S NEXT The Minnesota Legislature has adjourned. Assuming that Governor Walz signs the bills into law, the implications of the 2020-2021 biennial budget and policy bills adopted this year are numerous. There will be many opportunities for you to find out more: June Region Forums (seven locations across the state) | www.careproviders.org/regions Legislative update webinar on June 19, 2019 | www.careproviders.org/learning Electronic monitoring webinar, Fall 2019 | www.careproviders.org/learning Care Providers of Minnesota 2019 Convention and Exposition | www.careproviders.org/convention
CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION
ASSISTED LIVING LICENSURE
SUMMARY
ASSISTED LIVING LICENSURE FRAMEWORK
The licensure framework will apply to all assisted living settings; there are specific exemptions from this licensure such as transitional housing, residential settings under 245A, and privately-owned communities such as co-ops. There will be two levels of licensure: assisted living and assisted living with dementia care. The license will cover all services, unit lease, and physical plant requirements. Residents will still have the option to receive services from an outside provider. New licensure fees will begin in 2021 and are set at a level to support surveys every other year. Assisted living fees will be $2,000 per building plus $75.00 per resident. Assisted living with dementia care fees will be $3,000 plus $100.00 per resident. There will be a rule-making process starting on July 1, 2019 to detail out some of the specific provisions.
MIN NIMUM ASSISTEDD LIVING FACILITY QUIREMENTS REQ
AUGUST 1, 2021: ASSISTEDD LIVING LICENSSURE
The 150-page assisted living licensure bill is a compilation of current and new laws intended to establish clarity of expectations for assisted living facilities and guidance to the state agency responsible to license such entities and survey for compliance. Knowing all of the requirements will be essential prior to August 1, 2021, however, included are some key areas of change for your review— details about each of the sections and resources for compliance will be available long before implementation.
careproviders.org/advocacy
This section sets out general expectations of all assisted living facilities such as: distributing the bill of rights; providing service in compliance with the Nurse Practice Act; developing and implementing a staffing plan; ensuring one or more persons are available 24 hours/day who are awake; a listing of services that must be provided or made available such as food, housekeeping, and laundry; a list of policies and procedures; requiring an infection control program; requiring resident and family councils; and delineating a resident grievance procedure. It should be noted that many of these requirements are already in place under the comprehensive home care license law.
ASSISTED LIVING BILL OF RIGHTS
The comprehensive home care bill of rights was used as the base for the new assisted living bill of rights with a few additions/edits. For example, the right to organize and participate in resident and/or family councils was inserted as a right.
BUSINESS OPERATIONS
Several requirements can be found under this section of law. • Several provisions related to handling resident finances and property, including a requirement to provide a final statement and funds within 30 days of a termination or death • Facility must develop and implement an individualized abuse prevention plan for each resident • Specific employee records must be maintained • Facility must establish and maintain a comprehensive tuberculosis (TB) infection control program • Written emergency disaster plan and emergency disaster training for all staff
CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION
MEDICATION MANAGGEMENT
Much of the language regarding medication management for comprehensive home care settings was moved into the assisted living law. An assisted living facility that provides medication management services must develop, implement, and maintain specific medication management policies and procedures. The law specifies: who can delegate medication administration and how; documentation requirements; medication management for residents who will be away from home; and storage and disposition of medications.
ASSISTED LIVING LICENSURE
SUMMARY
LICEN NSE APPLICATIONS & CONTROLLING INDIVIDUAL RESTTRICTIONS
The new law gives the commissioner of health authorization to deny licensure—initial or renewal—under certain circumstances such as prior history with nursing facilities or other assisted living facilities; and establishes stays of revocations or non-renewals under certain conditions.
PHYSICAL PLANT
On or after August 21, 2021, MDH engineering will be reviewing & must approve architectural & engineering plans for new AL construction; MDH engineering will be conducting on-site inspections of each licensed AL building, on a frequency of at least once every two years. It is our assumption this building inspection will coincide with the survey of the licensed AL facility. On or after August 21, 2021, each licensed AL facility must have a comprehensive fire protection system to include the following: • Approved sprinkler system or smoke detectors in each occupied room • Portable fire extinguishers • Physical environment kept in a “continuous state of good repair and operation” • A maintenance & repair program must be in place • Fire drills conducted in accordance with Life Safety Code (one every two months, with two being at night) • Existing buildings must be maintained in a manner that does not constitute a distinct hazard to life • New construction must meeting the following requirements: • Facilities with six or more residents must meet the AL requirements in the Facility Guidelines Institute (FGI) “Guidelines for Design & Construction of Residential Health, Care & Support Facilities” • Facilities with six or more residents must comply with the Residential Board & Care Occupancy chapter of the NFPA 101 (Life Safety Code) • Licensed AL with dementia care facilities that have a secured unit have the following additional requirements: • Compliance with the Healthcare (limited care) chapter of the NFPA 101 • A hazard vulnerability analysis or safety risk assessment must be completed to identify property & ground risks for residents & mitigation strategies to protect residents from harm • Be fully sprinkled by August 1, 2029
ASSISTTED LIVING CONTRACT REQUIREMENTS
All current contracts with residents will need to be revised to take into account a singular license (rather than a separate lease and service agreement), as well as the specific provisions that must be included in the contract included in this law. The language in the bill does not preclude a facility from creating a two-part contract with one part describing the lease expectations and the other part delineating the services.
RESIDEN NT ASSESSM MENT & SERVICCES Key to ensuring we minimize the numbers of involuntary terminations or nonrenewals of housing is making sure those moving into our assisted living facilities can be served; that there is an awareness of service needs; and that there is a process in place for reassessments and communication as needs change. Each resident moving in who will be receiving services from the assisted living facility must have an assessment conducted by a registered nurse prior to the move-in date, or contract execution date, whichever is earlier. Resident reassessment needs to be conducted within two weeks after initiation of services and a written service plan developed.
CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION
SURVEYSS & FINES
Surveys will be conducted at least once every two years, with details on when follow-up surveys will be required/optional. The law delineates the fines associated with non-compliance at each level and defines the level and scope of violations. The commissioner MAY issue immediate fines for level 3 and level 4 correction orders or findings of maltreatment. The law further specifies a reconsideration of correction orders and fines process and the various remedies available to the commissioner for enforcement.
ASSISTED LIVING LICENSURE
SUMMARY
NEW W PROCEDURES FOR CO ONTRACT TERMINATIONS & CONSUMER APPEAL RIGHTS There are new notice and discharge planning requirements for situations that require a contract termination and a new appeals process with the Office of Administrative Hearings for consumers wishing to contest a contract termination. There are separate terms and processes for termination for nonpayment, termination for violations of the contract, and expedited termination where there are health and safety issues involving other residents or facility staff. Emergency relocations are allowed with specific notice requirements; however, a facility shall not refuse to allow a resident to return if a termination of housing has not been effectuated. For situations where a facility just decides not to renew a resident’s housing under a contract, there are requirements that the facility either give 60 days’ notice of the nonrenewal and help with relocation planning or follow the termination procedure. Regardless of how a resident is moved from the facility (termination, service reduction, planned closure), there are requirements for facilities to help coordinate the move, including development of a relocation plan that includes a “safe location.”
RETALIATION PROHIBITED
Retaliation against residents/families/employees was an important issue for the consumer advocates as there were many examples provided where the families felt they were being retaliated against if they complained formally or informally; or placed an electronic monitoring device in a resident’s room. This new law states that an assisted living facility or agent of the facility may not retaliate against a resident, or employee if the resident, employee, or person acting on behalf of the resident files a good faith complaint; grievance; maltreatment report; or places an electronic monitoring device in the room. What constitutes retaliation against a resident is further defined and includes actions such as: discharges or transfers; restrictions or prohibition of access; restriction of rights; unauthorized removal or tampering of electronic monitoring devices. Retaliation against an employee for reporting complaints/grievances includes unwarranted discharge or transfer; demotions or refusal to promote; reduction in compensation; imposition of discipline. The commissioner can take enforcement action if it was determined that a retaliatory action took place within 30 days of a complaint or related activity happening.
RESIDENT QUALIITY OF CARE & OUTCO OMES IMPROVEMENT TAASK FORCE
The task force is to be established by July 1, 2020, with specified members and the goal of periodically providing recommendations on changes needed to promote safety and quality improvement practices in long-term care settings and with long-term care providers.
DEMENTIA CARE
Additional requirements are identified for assisted living facilities that advertise, market, or otherwise promote as providing specialized care for individuals with Alzheimer’s disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care. Facilities with this designation must demonstrate the capacity to manage residents with dementia, comply with the additional staffing and staff training requirements, and provide some specific services as needed by each resident.
careproviders.org/advocacy CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION
ASSISTED LIVING LICENSURE
SUMMARY
“I’M OKAY” CHECKS
Concerns about independent living settings providing services without accountability and transparency for consumers led to a section of law titled “I’m okay” check services. Unlicensed settings—which provide sleeping accommodations to one or more adults, at least 80 percent of whom are 55 years of age or older, and offering or providing for a fee any supportive services (like housekeeping, meals, or laundry)—must disclose in a written contract whether they will or will not offer “I’m okay” checks. If the resident contracts for “I’m okay” check services in this otherwise independent living setting, there must be details on the nature, extent, and frequency in the contract.
NEW QUALIFICATIONS FOR ASSISTED LIVING DIREECTORS
Assisted living directors will be ultimately in charge of the assisted living facility, so the law builds in initial requirements and ongoing training for this position. The examination and continuing education will be monitored by the Board of Executives for Long-Term Services and Supports (formerly the nursing home examiner board). In order to be qualified to serve as an assisted living director, an individual must: 1. have completed an approved training course and passed an examination approved by the board that is designed to test for competence and that includes assisted living facility laws in Minnesota; 2. (i) currently be licensed as a nursing home administrator or have been validated as a qualified health services executive by the National Association of Long-Term Care Administrator Boards; and (ii) have core knowledge of assisted living facility laws; or 3. apply for licensure by July 1, 2021, and satisfy one of the following: • have a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance; • have at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility; • have completed at least 1,000 hours of an executive-in-training program provided by an assisted living director licensed under this subdivision; or • have managed a housing with services establishment operating under assisted living title protection for at least three years.
Together, we developed solutions. Seniors should be able to live independently for as long as they are able, with access to the safe, quality care options they need, in the communities they call home. Protection of vulnerable adults lies at the very core of our work and is best accomplished through partnerships. We have worked to ensure that we have a system that balances the values of independence and choice with the values of safety and protection.
CARE PROVIDERS OF MINNESOTA | 2019 ASSISTED LIVING LICENSURE & OLDER ADULT PROTECTIONS LEGISLATION
CARE PROVIDERS OF MINNESOTA’S
ADVOCACY TEAM
Toby Pearson
Vice President of Advocacy tpearson@careproviders.org 952-851-2480
Nicole Mattson
Vice President of Strategic Initiatives nmattson@careproviders.org 952-851-2482
Patti Cullen, CAE
Todd Bergstrom
Doug Beardsley
Jill Schewe
President/CEO pcullen@careproviders.org 952-851-2487
Vice President of Member Services pdbeardsl@careproviders.org 952-851-2489
facebook.com/CPofMN twitter.com/CPofMN
CARE PROVIDERS OF MINNESOTA 7851 Metro Parkway, Suite 200 Bloomington, MN 55425
Director of Research & Data Analysis tbergstrom@careproviders.org 952-851-2486
Director of Assisted Living, Housing & Home Care jschewe@careproviders.org 952-851-2484
Kaila May
Communications & Website Specialist kmay@careproviders.org 952-851-2495
linkedin.com/company/CPofMN youtube.com/user/careprovidersofMN
December 30, 2019
www.careproviders.org 1-952-854-2844 MN Toll-Free 1-800-462-0024
##
Retaliation Prohibited in Registered Housing with Services Establishments with Assisted Living Title Protection Effective August 1, 2019, and expires July 31, 2021 [144G.07] RETALIATION PROHIBITED. Subdivision 1. Definitions. For the purposes of this section: (1) "facility" means a housing with services establishment registered under section 144D.02 and operating under title protection under this chapter; and (2) "resident" means a resident of a facility. Subd. 2. Retaliation prohibited. A facility or agent of a facility may not retaliate against a resident or employee if the resident, employee, or any person on behalf of the resident: (1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; (2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; (3) files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary, under section 626.557; (4) seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the administrator or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; (5) advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights under this section or other law; (6) takes or indicates an intention to take civil action; (7) participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; (8) contracts or indicates an intention to contract to receive services from a service provider of the resident's choice other than the facility; or (9) places or indicates an intention to place a camera or electronic monitoring device in the resident's private space as provided under section 144.6502. Subd. 3. Retaliation against a resident. For purposes of this section, to retaliate against a resident includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a resident, or any person with a familial, personal, legal, or professional relationship with the resident: (1) termination of a contract; (2) any form of discrimination; (3) restriction or prohibition of access: (i) of the resident to the facility or visitors; or (ii) of a family member or a person with a personal, legal, or professional relationship with the resident, to the resident, unless the restriction is the result of a court order; (4) the imposition of involuntary seclusion or the withholding of food, care, or services; (5) restriction of any of the rights granted to residents under state or federal law; (6) restriction or reduction of access to or use of amenities, care, services, privileges, or living arrangements; (7) an arbitrary increase in charges or fees;
(8) unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices; or (9) any oral or written communication of false information about a person advocating on behalf of the resident. Subd. 4. Retaliation against an employee. For purposes of this section, to retaliate against an employee means any of the following actions taken by the facility or an agent of the facility against an employee: (1) unwarranted discharge or transfer; (2) unwarranted demotion or refusal to promote; (3) unwarranted reduction in compensation, benefits, or privileges; (4) the unwarranted imposition of discipline, punishment, or a sanction or penalty; or (5) any form of unwarranted discrimination. Subd. 5. Determination by commissioner. A resident may request that the commissioner determine whether the facility retaliated against a resident. If a resident demonstrates to the commissioner that the facility took any action described in subdivision 3 within 30 days of an initial action described in subdivision 2, the facility must present evidence to the commissioner of the nonretaliatory reason relied on by the facility for the facility action. Based on the evidence provided by both parties, the commissioner shall determine if retaliation occurred.
POLICY: RETALIATION PROHIBITED DATE ENACTED/REVIEWED: August 1, 2019 DATE WITHDRWAWN: July 31, 2021 AUTHORIZED SIGNATURE:___________________________________
It is the policy of XXXXXX to not retaliate against a resident or employee if the resident, employee, or any person acting on behalf of the client or tenant: 1. files a good faith complaint or grievance, makes a good faith inquiry, or asserts any right; 2. indicates a good faith intention to file a complaint or grievance, make an inquiry, or assert any right; 3. files, in good faith, or indicates an intention to file a maltreatment report, whether mandatory or voluntary 4. seeks assistance from or reports a reasonable suspicion of a crime or systemic problems or concerns to the administrator or manager of the facility, the Office of Ombudsman for Long-Term Care, a regulatory or other government agency, or a legal or advocacy organization; 5. advocates or seeks advocacy assistance for necessary or improved care or services or enforcement of rights; 6. takes or indicates an intention to take civil action; 7. participates or indicates an intention to participate in any investigation or administrative or judicial proceeding; 8. contracts or indicates an intention to contract to receive services from a service provider of the client’s or tenant’s choice other than the facility; or 9. places or indicates an intention to place a camera or electronic monitoring device in the client’s private space as provided under section 144.6502. Retaliation against a client or tenant includes but is not limited to any of the following actions taken or threatened by a facility or an agent of the facility against a client or tenant, or any person with a familial, personal, legal, or professional relationship with the client or tenant: 1. termination of a contract; 2. any form of discrimination; 3. restriction or prohibition of access: i. of the client or tenant to the facility or visitors; or ii. of a family member or a person with a personal, legal, or professional relationship with the client or tenant to the client or tenant, unless the restriction is the result of a court order;| 4. the imposition of involuntary seclusion or the withholding of food, care, or services; 5. restriction of any of the rights granted to residents under state or federal law; 6. restriction or reduction of access to or use of amenities, care, services, privileges, or living 7. arrangements; 8. unauthorized removal, tampering with, or deprivation of technology, communication, or electronic monitoring devices; or 9. any oral or written communication of false information about a person advocating on behalf of the client or tenant. Retaliation against an employee means any of the following actions taken by the facility or an agent of the facility against an employee: 1. unwarranted discharge or transfer;
2. 3. 4. 5.
unwarranted demotion or refusal to promote; unwarranted reduction in compensation, benefits, or privileges; the unwarranted imposition of discipline, punishment, or a sanction or penalty; or any form of unwarranted discrimination.
Complaints of suspected retaliation should be brought to the attention of the community’s Director, Compliance Officer, or the Minnesota Commissioner of Health.
Do I need an Assisted Living Facility License or an Assisted Living Facility with Dementia Care License? YES
NO
Are you a facility that provides sleeping accommodations to one or more adults
Are you any of the following? An emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals (see 116L.361) A nursing home (144A), or a hospital , boarding care home, or licensed supervised living facility (144.50-144.56) A licensed lodging establishment Residential settings licensed under 245A, or adult foster care (245D) A private home in which the residents are related by kinship, law, or affinity with the providers of services A duly organized condominium, cooperative, or common interest community where at least 80% of the units are owners, members, or shareholders of the units A temporary family health care dwelling (394.307 & 426.3593) A setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing Housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services Rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q Rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56 Rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011
NO
You are not required to have an AL License
YES
Do you provide one or more of the following Assistance with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing Standby assistance Verbal or visual reminders to residents to take regularly scheduled medication(s), which includes bring the resident previously set-up medication(s), medication(s) in original containers, or liquid or food to accompany the medication(s) Verbal or visual reminders to the resident to perform regularly scheduled treatments and/or exercises The preparation of modified diets ordered by a licensed health professional The services of an advanced practice registered nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker Tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional within the person’s scope of practice Medication management services Hands-on assistance with transfers and mobility Treatments and therapies Assistance for residents with eating when the residents have complicated eating problems Complex or specialty health care services
YES You need an AL
NO
license
Does either of the following apply to your facility? You are required to have an Assisted Living Facility with Dementia Care license
You advertise, market, or otherwise promote yourself an assisted living as providing specialized care for dementia or related disorders.
YES
You have a secured dementia care unit, meaning a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident’s ability to exit, the secured area or setting.
NO
You are required to have an Assisted Living Facility License. You have the option to have an Assisted Living Facility with Dementia Care license.
© Care Providers of Minnesota 5/19 1.3
Assisted Living Director Licensure By August 1, 2021, each Licensed Assisted Living Facility in Minnesota must be managed by a Licensed Assisted Living Director. There are three “routes” available to become a Licensed Assisted Living Director:
OPTION 1 (to be developed)
Has completed an approved training course and passed an examination approved by the Board of Executives for Long Term Services and Supports (formally BENHA) that is designed to test for competence and that includes assisted living facility laws in Minnesota
OPTION 2
Is a Licensed Nursing Home Administrator or has been validated as a Qualified Health Services Executive by the National Association of LongTerm Care Administrator Boards (NAB) and has a core knowledge of Minnesota Assisted Living laws (how to define and measure core knowledge is still to be determined)
OPTION 3
(“grandfathering” options)
Apply for licensure by July 1, 2021 AND satisfy at least ONE of the following requirements
Has a higher education degree in nursing, social services, or mental health, or another professional degree with training specific to management and regulatory compliance
Has completed at least 1,000 hours of a director/ executive in training program provided by a licensed assisted living director
Has managed a registered housing with services establishment under assisted living title protection for at least three years
Has at least three years of supervisory, management, or operational experience and higher education training applicable to an assisted living facility
Assisted Living Director licenses will be managed by the Minnesota Board of Executives for Long Term Services and Supports (formerly the Board of Examiners for Nursing Home Administrators/BENHA). Each Licensed Assisted Living Director must receive at least 30 hours of training every two years on topics relevant to the operation of a Licensed Assisted Living Facility and the needs to its residents. If the Licensed Assisted Living Director is managing a Licensed Assisted Living with Dementia Care, the Director must complete and document that at least 10 hours of the required 30 hours of training relate to the care of individuals with dementia. Care Providers of Minnesota 8/19
Compliance with Minnesota’s §325F.721 “I’m okay” Check Services Statue Are you an unlicensed setting providing sleeping accommodations to one or more adult residents, at least 80% which are 55 years of age or older
YES
NO
Do you, for a fee, offer any of the following supportive services? Assistance with laundry Assistance with shopping Assistance with household chores Housekeeping services Provision or assistance with meals or food preparation Help with arranging for, on arranging transportation to, medical, social, recreational, personal, or social services appointments Provision of social or recreational services
YES
The “I’m okay” statute does not apply to you.
NO
Are you any of the following? Emergency shelter, transitional housing, or any other residential units serving exclusively or primarily homeless individuals (see 116L.361) A nursing home A hospital A certified boarding care home A licensed supervised living facility A licensed lodging establishment Residential settings licensed under 245A Adult foster care An assisted living facility licensed under chapter 144I A setting governed by the standards of 245D A private home in which the residents are related by kinship, law, or affinity with the providers of services A duly organized condominium, cooperative, or common interest community where at least 80% of the units are owners, members, or shareholders of the units A temporary family health care dwelling (394.307 & 426.3593) A setting offering services conducted by and for the adherents of any recognized church or religious denomination for its members exclusively through spiritual means or by prayer for healing Housing financed pursuant to sections 462A.37 and 462A.375, units financed with low-income housing tax credits pursuant to United States Code, title 26, section 42, and units financed by the Minnesota Housing Finance Agency that are intended to serve individuals with disabilities or individuals who are homeless, except for those developments that market or hold themselves out as assisted living facilities and provide assisted living services Rental housing developed under United States Code, title 42, section 1437, or United States Code, title 12, section 1701q Rental housing designated for occupancy by only elderly or elderly and disabled residents under United States Code, title 42, section 1437e, or rental housing for qualifying families under Code of Federal Regulations, title 24, section 983.56 Rental housing funded under United States Code, title 42, chapter 89, or United States Code, title 42, section 8011
The “I’m okay” statute does not apply to you.
YES
NO
Effective with contracts entered into on or after August 21, 2021, you must comply with the following three requirements:
You must disclose to prospective residents that the facility is not licensed as an assisted living facility under chapter 144I and, notwithstanding any contract for "I'm okay" check services, is not permitted to provide assisted living services, as defined in section 144I.01, subdivision 9, either directly or through a provider under a business relationship or other affiliation with the covered setting. You must prominently disclose in a written contract whether or not your setting itself or through a provider with which the your setting has a business agreement offers "I'm okay" check services. If the resident contracts for "I'm okay" check services, the written contract must detail the nature, extent, and frequency of the provision of these services. © Care Providers of Minnesota 5/19
2021 NURSE MANAGERS’ EDUCATION SERIES
FAQs ELECTRONIC MONITORING THE BASICS 1
When will this new law go into effect? January 1, 2020.
2
What type of facilities are covered by this new law? • Nursing facilities licensed under chapter 144A • Boarding care homes licensed under sections 144.50 to 144.56 • Between January 1, 2020, and August 1, 2021, a registered (144D) housing with services establishment that is either subject to 144G (assisted living title protection) or has disclosed a special care unit under section 325F.72 • Beginning August 1, 2021, licensed assisted living facilities
3
Can my facility prohibit electronic monitoring? Effective January 1, 2020—No.
4
Can my facility refuse to admit or initiate the discharge of a resident or client who intends to, or is, utilizing electronic monitoring? Effective January 1, 2020—No.
5
Does the electronic monitoring law apply to facility-installed cameras in public areas of the building or in areas of the building only accessible by facility staff ? No—The law applies to electronic monitoring initiated by the resident, client, or their representative, to be installed in the resident’s or client’s private living space.
6
Does this law apply to electronic monitoring outside of a resident’s private living space (e.g., meetings, conference rooms, etc.)? No—The law only applies to the resident’s or client’s private living space.
7
What is considered an “electronic monitoring device”? A camera or other device that captures, records, or broadcasts audio, video, or both, that is placed in a resident’s or client’s room or private living unit and is used to monitor the resident/client or activities in the room/private living unit.
8
Will my facility be required to purchase, install, or maintain an electronic monitoring device for a resident or client? No—It is the responsibility of the resident, client, or their representative to purchase, pay for installation, and pay for maintenance of an electronic monitoring device.
9
What are the consequences against a facility for not complying with this new electronic monitoring law? Failing to comply may result in a $500 fine.
10
Is a facility allowed to share with staff when electronic monitoring is installed? The law is silent in this area. However, if the consent form indicates any restrictions or conditions that the facility directs staff to accommodate, applicable staff would need to be notified of such restrictions or conditions.
11
What happens with electronic monitoring devices in-place prior to January 1, 2020? Effective January 1, 2020, such devices will need to have a consent and notification form consistent with the new law. Facilities should provide residents and/or resident representatives with the MDH-approved consent forms (http://bit.ly/EMconsentforms) and notify them that proper consent must be received or the device will be disabled.
FAQs | ELECTRONIC MONITORING THE BASICS CONTINUED... 12
What should I do if my staff comes across an electronic monitoring device in a private living space? First, they should always be acting in a manner under which they assume they are being monitored. Second, they should contact the administrator or manager, so leadership can confirm if a consent form has, or has not, been provided to the facility. If a consent form has not been received by the facility, leadership should contact the Office of Ombudsman for Long-Term Care (OOLTC) to determine if OOLTC was provided a signed consent form. If the OOLTC confirms a consent form has been received, the facility should verify the consent is not dated more than 14 days prior and compare information regarding the electronic monitoring device provided by the OOLTC with the device that was discovered, to verify it is the correct device and consent form on file. If no consent was received, the facility should contact the resident representative to have the device removed or proper consent provided. The facility may disable the device until proper consent and notification is received but should not remove the device as it does not belong to the facility.
13
Nursing facilities are required to pull privacy curtains to maintain the dignity of residents during personal cares. If pulling the privacy curtain would block the electronic monitoring field of view, what should staff do? Representatives from the Minnesota Department of Health (MDH) have indicated if a resident has consented to having personal cares monitored electronically, which means the privacy curtain would NOT be pulled if the electronic device would be blocked by the curtain, the facility will not be cited for failing to pull the privacy curtain due to the directed request of the resident (person-centered care).
14
If an electronic monitoring device is installed, can it have an extension cord or surge protector strip utilized to reach an outlet? Not in a nursing facility—That would violate requirements in the NFPA Life Safety Codes and required referenced codes.
15
The webinar mentioned the potential issue of a resident/client moving around in public areas of the building with an electronic monitoring device in a teddy bear on his or her lap. How should this situation be handled? The law does not address this scenario. The facility response may depend on what is being streamed from the device. Is it an event like a picnic or activity that the resident wants to share, or is it simply streaming everything and anything that is within the device’s recording range? The main concern would be that the device is streaming images and audio of other residents who have not consented to having their images or audio streamed or recorded by an outside entity or person. This scenario would need to be discussed with the resident or resident’s representative to limit unintended privacy breaches.
2
16
A family has installed an electronic device consistent with the law, and the family is calling the facility a lot to address issues captured by the device (the question was unclear regarding the type of issues). As a result, staff are spending significant amounts of time checking on the resident and speaking with the family. Can the facility charge extra for this additional staff time? In a nursing facility—no. In a housing with services/assisted living—maybe, if the result is acknowledged increased care/service needs of the resident that are added to the service plan relating to their assessed needs. Charging the resident more as a result of the facility’s frequent interaction with the family would most likely be viewed as retaliation, which is prohibited.
17
Does this law include swing beds in hospitals? No—The law does not apply to swing beds in hospitals.
18
Will this law mean a change to the Bill of Rights? The Assisted Living Bill of Rights (http://bit.ly/MDH_AL_BOR) was modified to include electronic monitoring. The Nursing Facility Bill of Rights was not modified.
19
Will Care Providers of Minnesota be providing members with a sample electronic monitoring policy? Yes, we will! Each facility will need to modify the sample to fit the approaches used by the facility.
©CARE PROVIDERS OF MINNESOTA | December 30, 2019
FAQs | ELECTRONIC MONITORING CONSENT 1
Does the resident or client need to consent to the placement of an electronic monitoring device that will be installed in the resident’s or client’s private living space? Yes—A resident or client must consent to electronic monitoring in the resident’s/client’s room or private living unit in writing on a standardized notice and consent form. The forms were developed by the Minnesota Department of Health and are available here: http://bit.ly/EMconsentforms. There are exceptions permitting those legally authorized to act on behalf of a resident or resident-identified resident representative when a resident is unable to consent on his or her behalf (such as issues surrounding capacity of residents; or clients lacking the ability to understand and appreciate the nature and consequences of electronic monitoring).
2
How are “cognitive issues” defined? The law does not define cognition or capacity. Instead, the law states the following: A resident must consent to electronic monitoring in the resident’s room or private living unit in writing on a notification and consent form. If the resident has not affirmatively objected to electronic monitoring and the resident’s medical professional determines that the resident currently lacks the ability to understand and appreciate the nature and consequences of electronic monitoring, the resident representative may consent on behalf of the resident. For purposes of this subdivision, a resident affirmatively objects when the resident orally, visually, or through the use of auxiliary aids or services declines electronic monitoring.
3
Must a resident, client, or their authorized representative provide the facility with a copy of the executed consent form? Yes—Notice of the consent to authorize electronic monitoring must be provided to the facility in advance of the installation of electronic monitoring. The facility must place the original consent form in the resident’s or client’s file.
4
Are there exceptions to requiring the consent form be provided to the facility in advance of the installation of electronic monitoring? Yes—If a resident, client, or authorized representative reasonably fears retaliation against them as a result of the planned installation of electronic monitoring, they can instead provide the executed consent form to the Office of Ombudsman for LongTerm Care instead of to the facility. However, this exception has two additional requirements: 1. A er 14 days using this exception, the resident, client, or authorized representative must provide a copy of the executed consent form to the facility. 2. During the 14-day period, if the resident, client, or authorized representative obtains evidence from the electronic monitoring device that suspected maltreatment occurred, they must timely submit their maltreatment concern to the Minnesota Adult Abuse Center (MAARC), the police, or both.
5
Are there other exceptions to requiring the consent form be provided to the facility in advance of the installation of electronic monitoring? Yes—Two other exceptions exist in the law: 1. If there has not been a timely, written response from the facility to a written communication from the resident, client, or their authorized representative expressing a concern, they can provide the executed consent form to the Office of Ombudsman for Long-Term Care instead of to the facility (the 14-day maximum period before providing notice to the facility still applies) 2. If the resident, client, or their authorized representative has already submitted a concern to MAARC or police, they can provide the executed consent form to the Ombudsman for Long-Term Care instead of to the facility (the 14-day maximum period before providing notice to the facility still applies)
6
Can the resident, client, or their authorized representative put restrictions on when the electronic monitoring device can and cannot be used? Yes—The consent form has a standard list of situations where electronic monitoring may be restricted or prohibited, such as during dressing, bathing, medical exams, etc.
7
3
Does a facility need to allow limitations or conditions to be placed on the use of electronic monitoring? Yes—The law requires the consent form to provide the option to place conditions on the use of electronic monitoring, therefore, the facility cannot prohibit such limitations or conditions. It remains unclear whose responsibility it is to accommodate any conditions—it is something a facility should consider discussing with the resident or resident’s representative when a consent form is received. A facility is not prohibited from forbidding staff or contractors to interact with the electronic monitoring device, even to accommodate conditions.
©CARE PROVIDERS OF MINNESOTA | December 30, 2019
FAQs | ELECTRONIC MONITORING CONSENT CONTINUED... 8
If neither the ombudsman or facility has an executed consent and notification form, how much time does the resident or authorized representative have in order to come and remove the device or comply with the law? If they live 4–5 hours away it won’t be same day, so then do we let the device remain on? That could be days. A er communicating with the resident or authorized representative that the device is not permitted because the requirements of the law are not being followed (and explaining how the device could be used with proper consent and notification), it is reasonable for the facility to disable the device, but not remove it. This may mean turning it off, unplugging it, or removing the battery.
9
What if the resident representative is also a member of the facility staff? Facility staff are not be permitted to act in the capacity of a resident’s representative.
10
Will there be a consent withdrawal form? An area to document withdrawal of the consent is a required element on the consent form.
11
When will the approved consent and notification form be available? On December 24, 2019, MDH published the approved consent and notification forms, which are available online here: http://bit.ly/EMconsentforms
ROOMMATES—SHARED PRIVATE LIVING SPACE 1
If a resident or client lives in a double room or shared living space that will be monitored by an electronic monitoring device, must the roommate also give consent? Yes—The same consent procedures are required for roommates.
2
What happens when a roommate objects to the placement of an electronic monitoring device? The resident, client, or authorized representative is prohibited from installing the electronic monitoring device. If requested, the facility must make a reasonable attempt to accommodate the resident or client who wants to conduct electronic monitoring—this includes offering the resident or client a move to another shared room with a roommate who gives consent for electronic monitoring or to a private room. The facility is not responsible to pay for the costs of the move or increased costs for the alternative room. The facility shall reevaluate the move request every two weeks until the request is fulfilled.
3
Is a spouse considered a roommate under this statute? The law does not address this question. “Roommate” is described in the statue as “any other resident residing in the shared room or shared private living unit,” therefore, it is assumed the roommate restrictions would apply even if the roommate was the spouse of a resident.
4
Who verifies that the roommate has the capacity to consent if the consent is going to the ombudsman? The law is silent on this issue. However, a facility should use caution to avoid the perception of putting up roadblocks or barriers to implementation of electronic monitoring. It is unclear what the Office of Ombudsman for Long-Term Care (OOLTC) will do with the consent and notification forms they receive. If a facility verifies with the OOLTC that consent was provided by the resident/ authorized representative and, when applicable, the roommate/roommate’s authorized representative, and the facility has concerns about the capacity of either to provide consent, the facility should request the OOLTC look into the validity of such consent and notification.
5
How will this affect shared rooms? If by “shared rooms” you mean bedrooms or living spaces with a roommate, then all the requirements of consent and notification apply to both the resident and roommate. If you define two private rooms with a shared bathroom as a shared room, the requirements would apply independently to each of the residents in their own private rooms.
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©CARE PROVIDERS OF MINNESOTA | December 30, 2019
FAQs | ELECTRONIC MONITORING WI-FI / INTERNET 1
Must I install or provide free internet access to residents or clients? No—However, if you do make internet access available to residents, tenants, clients, or visitors, you must also make it available for electronic monitoring purposes under the same terms.
2
Is a facility required to provide public Wi-Fi? No—The law states the following: • If a resident chooses to place an electronic monitoring device that uses internet technology for visual or audio monitoring, the resident may be responsible for contracting with an internet service provider. • The facility shall make a reasonable attempt to accommodate the resident’s installation needs, including allowing access to the facility’s public-use internet or Wi-Fi systems when available for other public uses. A facility has the burden of proving that a requested accommodation is not reasonable.
3
Do I need to make my “public” internet secure? No—Many facilities have a secure private/business internet service, and a separate unsecured public internet service. Note—If this is the case, persons who have access to the public internet service should be informed that the connection is not secure. If your public internet service is secure, you should follow and communicate standard best practices for secure sites—such as encrypting the secure connection by one or more security protocols (such as passwords and/or secure sockets layer/SSL) to ensure the security of data flowing between two or more nodes.
4
What if the facility’s public Wi-Fi is not secure? This should be disclosed in your resident handbook or however you communicate your information regarding your public Wi-Fi. When a consent and notification form is received, you may want to communicate that fact again to the resident or authorized representative (document such communication).
5
Are we allowed to limit the use of our public Wi-Fi to certain uses? If you have public Wi-Fi, and if a resident desires to utilize electronic monitoring within the terms of the law and wants to use the public Wi-Fi, the facility will have the burden of proving that allowing access to the facility’s public-use Wi-Fi is not a reasonable accommodation.
6
What does the word “reasonable” mean? The law does not define the term “reasonable” in this statute. Merriam-Webster® defines it as “not extreme or excessive.” Other definitions use statements such as “as much as is appropriate or fair,” or “fair and sensible.”
7
We provide free Wi-Fi for guests. We do not allow continued use of Wi-Fi for such things as Netflix® or streaming. We have made some exceptions for individuals on EW who cannot afford their own Wi-Fi. Is this problematic? All users of Wi-Fi should be treated the same. If there is public Wi-Fi that all can use, that should remain the same. If there is a fee for faster or non-public Wi-Fi, then all should be charged the fee.
SIGNAGE 1
What type of signage must be used for electronic monitoring? A sign outside of the resident’s/tenant’s/client’s private living space is not required. However, the facility must post a sign at each facility entrance accessible to visitors that states the following: “Electronic monitoring devices, including security cameras & audio devices, may be present to record persons & activities.”
2
Does the electronic monitoring law prohibit a facility from posting signs at the doorway to a resident’s private living space indicating that electronic monitoring is occurring in the space? The law does not require or prohibit such signage at the entrance to a resident’s private living space. The signage posting requirement pertains to facility entrances from the outside that are available for public access into the building. Note—It is unclear in a nursing facility environment if surveyors would consider a posting outside a resident’s private living space as violating a “home-like atmosphere” or whether there would be an issue with “resident dignity.”
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©CARE PROVIDERS OF MINNESOTA | December 30, 2019
FAQs | ELECTRONIC MONITORING REPORTING 1
If a family puts an electronic monitoring device in a resident’s private living space against the resident’s wishes (or roommate’s wishes), should the facility report it under the Vulnerable Adults Act, call the police, or something else? The law does not address this situation. However, it sounds like a potentially volatile situation that should be addressed to protect the rights of the resident(s). Frankly, the police will not know what to do, so we would not advise calling them in as your first response. Same holds true for the VAA—while it may be appropriate for adult protection to be involved, they may determine that it is the facility’s responsibility to protect the resident(s) privacy rights in this situation. We would advise as your first step contacting the Office of Ombudsman for Long-Term Care and have them represent the interests of the resident(s).
2
If a resident with dementia wanders into a room where electronic monitoring is occurring, does the facility need to contact the wandering resident’s family because consent for audio or video recording had not been granted? The law does not address this scenario, but notification of such an event does not seem necessary.
3
When would a facility be required to report an electronic device to the Minnesota Adult Abuse Reporting Center (MAARC) or the Office of Health Facility Complaints (OHFC)? The law does not identify failure to follow the electronic monitoring requirements as potential maltreatment, abuse, neglect, or exploitation. If a facility feels that the county adult protective services needs to be involved, they should contact MAARC. It is suggested that a facility work with the resident’s authorized representative and the OOLTC first to get the issues resolved.
4
When would a facility be required to report an electronic device to law enforcement? The law identifies penalties against licensed providers for failing to comply with the law, but does not identify any legal ramifications for residents or authorized representatives, other than potential civil or criminal penalties for disseminating a recording or copy of a recording for purposes outside of addressing health, safety, or welfare concerns of one or more residents. It is suggested that a facility work with the resident’s authorized representative and the OOLTC first to get any issues resolved.
5
If the resident’s authorized representative witnesses maltreatment via the electronic monitoring device, are they required to report it? Yes—If it occurs during the 14-day period when the consent notice was provided to the Office of Ombudsman for Long-Term Care instead of to the facility.
MISCELLANEOUS 1
What happens to the recordings that are captured by electronic monitoring devices? The law is somewhat silent on this issue. However, the law does have the following restrictions in place: • No person may access any video or audio recording created through authorized electronic monitoring without the written consent of the resident or resident representative. • Except as required under other law, a recording or copy of a recording made as provided in the electronic monitoring law may only be disseminated for the purpose of addressing health, safety, or welfare concerns of one or more residents. A person disseminating a recording or copy of a recording made as provided in the electronic monitoring law may be civilly or criminally liable if it is disseminated for reasons other than the purpose of addressing health, safety, or welfare concerns of one or more residents. • Subject to applicable rules of evidence and procedure, any video or audio recording created through electronic monitoring may be admitted into evidence in a civil, criminal, or administrative proceeding. • For the purposes of state law, the mere presence of an electronic monitoring device in a resident’s room or private living unit is not a violation of the resident’s right to privacy. • For the purposes of state law, a facility or home care provider is not civilly or criminally liable for the mere disclosure by a resident or a resident representative of a recording.
2
If a recording captured by an electronic monitoring device causes a facility to initiate employee disciplinary actions, who has access to the recorded images? An employee of the facility or an employee of a contractor providing services at the facility, including an arranged home care provider, who is the subject of proposed disciplinary action based upon evidence obtained by electronic monitoring must be given access to that evidence for purposes of defending against the proposed action. An employee who obtains a recording or a copy of the recording must treat the recording or copy confidentially and must not further disseminate it to any other person except as required under law. Any copy of the recording must be returned to the facility or resident who provided the copy when it is no longer needed for purposes of defending against a proposed action.
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©CARE PROVIDERS OF MINNESOTA | December 30, 2019
FAQs | ELECTRONIC MONITORING MISCELLANEOUS CONTINUED... 3
If a family member purchases something like a baby monitoring device, and asks the facility to monitor it to identify falls or activity, is that electronic monitoring, and how should the facility respond? Interesting question! First, it appears a baby-monitoring type of device would be considered electronic monitoring, as it is a device that broadcasts audio, video, or both; placed in a resident’s room or private living space; and used to monitor the resident or activities in the resident’s room or private living space. Therefore, all components of the new electronic monitoring law would need to be met. The facility clearly has no duty to accept this obligation to monitor. If the facility did accept this responsibility, the facility should consider the following: • Have all components of the electronic monitoring law been met? • Can the facility continuously monitor the broadcast, if that is the expectation? • Can the broadcast be kept private, so that others cannot see/hear it? In most instances the answers would be no, indicating the facility may want to decline the monitoring of the broadcast.
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4
Why would providers not want to be proactive and put cameras in the rooms or private living area for facility purposes and then market that to the public that the facility has nothing to hide? If a facility were to do this, the same consent notice and ability to elect restrictions would be applicable for all current and new residents/clients (and roommates). Having such recordings could place an additional regulatory or legal burden on the facility in terms of responsibility.
5
If we know there is a camera in a room, and we know that and accidentally break it, I understand we may be responsible to replace that. What if it is a hidden camera in a tissue box and we move that for cleaning, and it breaks…is that our responsibility to replace that device? The law is silent on this issue. We assume when you are referring to “hidden camera” you mean an electronic monitoring device that complies with the new law. How does your facility handle the replacement of other resident personal items that staff unintentionally break?
6
What is a facility’s responsibility to maintain a resident’s electronic monitoring device/camera? The facility is not responsible for the maintenance of such device—It is the responsibility of the resident or resident’s authorized representative choosing to conduct the electronic monitoring.
7
Can we have rules about how devices are physically installed? The law is somewhat silent in this area, other than stating that installation costs are the responsibility of the resident. What limitations regarding the installation of other personal resident items, such as furnishings, pictures, TVs, mementos, or other belongings does your facility enforce?
8
Can a resident’s authorized electronic monitoring device be placed in a manner that it is also recording/transmitting images of common areas outside of the resident’s private living space? The law is somewhat silent in this area, but the consent and notification form is designed to only cover electronic monitoring in the resident’s private living space.
©CARE PROVIDERS OF MINNESOTA | December 30, 2019
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December 30, 2019
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