Assisted Living

Guide to Choosing an Assisted Living Community

What Minnesota Consumers Should Know About Assisted Living

ASSISTED LIVING IN MINNESOTA
Contrary to popular belief, assisted living is a service concept, not a "place." In Minnesota, assisted living encompasses a wide range of building types and service packages. A variety of settings offering assisted living services are available, giving consumers a wide range of options:

• Some market rate apartments have been designed specifically to serve frail seniors, while other "independent" buildings have made assisted living services available to residents who are "aging-in-place";
• Some subsidized apartment buildings now make assisted living services available to their residents who are aging-in-place;
• Licensed board and lodging establishments, which offer private or semi-private rooms without kitchens and basic services such as three meals per day and housekeeping, may also provide a full range of health-related assisted living services;
• Licensed adult foster care homes offer a full range of services to consumers who want a very small, home-like setting. A few adult foster care "suites" have been created within larger apartment buildings. Most of the corporate foster care homes in Minnesota are designed specifically to serve those with memory loss.

The service packages in these buildings can range from very light care to a full range of supportive and health-related services. Light care programs typically offer 1-2 meals per day, housekeeping, some assistance with activities of daily living (ADLs), assistance with transportation and laundry, recreation and socialization activities, and emergency call service. In addition to these services, more service-intense programs serving a very frail population usually provide all meals plus snacks; a full range of home care services, including medication administration and assistance; assistance in making and traveling to medical appointments; 24-hour staffing; and more.

Minnesota's system to insure quality for consumers living in these settings and using assisted living services has two components:

1) Building Requirements. Any building serving seniors that offers or provides certain supportive services or any type of health-related (i.e., home care) service is required to register with the Department of Health and must have a written contract with all residents. The contract must cover 17 pieces of information needed by consumers, such as:

• what services are included in the basic rent and what are available for an additional fee;
• how to amend the contract;
• how to make complaints;
• what criteria residents must meet in order to live in the building; and more.

In addition to this contract, buildings must comply with building/fire codes, must have a licensed kitchen in order to prepare congregate meals, and must meet a variety of other state and federal statutory requirements. Board and lodging establishments and foster care homes must carry a state license.

2) Service Requirements. Any health-related services provided in these buildings, such as help with dressing, grooming or bathing, assistance with self-administration of medications, administration of medications, central storage of medications, or other nursing or delegated nursing services, must be provided under a Minnesota Department of Health home care license. A home care license may be obtained by the same entity that owns the building, or the building may develop an arrangement with an outside home care agency to provide the assisted living services.

Source: Aging Services of Minnesota

WHAT MINNESOTA CONSUMERS SHOULD KNOW ABOUT ASSISTED LIVING

What is Assisted Living?

"Assisted living" is a coordinated program of services that can be found in a variety of residential settings for seniors. In Minnesota,these residential communities are called "housing-with-services establishments." These settings may be:

• Apartment buildings, where each resident has a private living space, kitchen and bathroom;
  
• Small homes, licensed as adult foster care homes, serving five residents or fewer and offering private or shared bedrooms and bathrooms and family-style dining;
  
• Small or large buildings, licensed as board and lodging, where residents have private or shared bedrooms and bathrooms and family-style dining; and
  
• Licensed boarding care homes with private or shared bedrooms and bathrooms and central dining.

If operators of these types of buildings advertise that they provide assisted living, they are required by Minnesota law to offer to residents at least the following services:

• Two meals each day;
  
• Housekeeping and laundry service available at least once a week;
  
• Help in arranging transportation to medical and similar appointments;
  
• Help in arranging social services and in accessing other community resources;
  
• Opportunities for socializing;
  
• Either assistance with self-administration of medications or administration of medications;
  
• Assistance with at least three of the following activities of daily living: bathing, dressing, grooming, eating, transferring, continence care and toileting;
  
• A system to check on each assisted living client at least daily;
  
• A system that enables assisted living clients to request and receive assistance with health or safety needs round-the-clock;

• An awake person, available round-the-clock to respond to assisted living clients' requests for assistance (In small settings with 12 or fewer clients, the person responsible for responding to requests is allowed to sleep if adequate safeguards are in place);
  
• Staff in an assisted living building must be able to reach a registered nurse 24 hours per day, seven days a week, regarding any health issue that may arise for a resident.

If you move to a setting that offers assisted living services, you are not required to use all of the services listed above. You can choose which services you want to receive. Many assisted living programs will offer many more services in addition to those minimum services listed above. Assisted living providers will provide you with a list of all the services they offer and the cost of these services.

If you move into a building with an assisted living program, you will pay a monthly base fee that covers your rent. Sometimes this monthly base fee will include some services, such as some meals or housekeeping services. In addition, you may have to pay additional fees for services not included in the monthly base fee--such as personal care services. Sometimes these additional services are "bundled" or grouped together and provided in "service packages," with a set charge for each type of package. Sometimes you may be able to purchase a single service for a set fee, "cafeteria style." As you consider assisted living services, be sure you get a good estimate of your total costs for rent and needed services. If you have limited resources, ask whether the provider accepts payments from any assistance programs and how to apply for these programs.

If you move into a building with assisted living services, you will probably sign many documents, including two types of contracts:

• You will sign a lease or residency agreement that lists the requirements you must meet to live in the building and spells out the services that the landlord promises to provide in exchange for the monthly rent or base fee.

If you will be using any personal care or health-related services, you also will sign a home care service plan or agreement that provides specific information about the services you are purchasing from the home care provider, which staff will provide the services, the cost of the services and more. The building owner or landlord may have a home care license and provide these services to you directly, or the landlord may arrange to have another agency with a home care license bring those services to you. If you need services that this provider doesn't offer--or you simply want a different home care provider--you can contract with another agency to provide the services you need. These documents are legal contracts and it is important to read them carefully and ask questions if there's something you do not understand. Many seniors ask a family member or trusted advisor to review these documents as well.

How Does Minnesota Regulate the Buildings Offering Assisted Living Services?
There are a variety of laws and regulations designed to protect the rights of people who live in senior housing and use assisted living services. Some of these requirements include:

• Minimum services that must be available in any building that advertises assisted living services, as well as other legal requirements for assisted living providers.
  
• Rights and responsibilities of both landlords and residents. A summary of these laws, Landlords and Tenants: Rights and Responsibilities, is available at
• Disclosure of written information on 17 important topics must be given to prospective residents by any housing-with-services establishment, including assisted living. This critical consumer information includes:
  • The basic monthly cost and what services are included What additional services are available and what these services cost
  • The building's residency requirements
  • Whether the building accepts any forms of public assistance, and more.
• Residential buildings offering memory care or dementia programs must give prospective residents and their families detailed, written information about the memory care program, such as specially-designed building features and memory care training given to staff. All of this required information is designed to give consumers the information they need to decide whether a program is right for them.
• Fire codes, building codes and other state laws are designed to make sure that the buildings people live in meet safety requirements. Some residential buildings are licensed as lodging establishments, adult foster care homes or boarding care homes and are inspected by the licensing agency. Kitchens where food is prepared for a number of residents must be licensed and inspected regularly.
• The federal Fair Housing Act and the Minnesota Human Rights Act prohibit discrimination in housing based on race, national origin, sex, disability, and other factors. The federal Americans with Disabilities Act provides additional protections for persons with disabilities. If you believe you have been the victim of discrimination, call the Minnesota Human Rights Commission at 651-296-5663 or 1-800-657-3704. [TTY: 651-296-1283.]

How Are Assisted Living Services Regulated?
Health-related services in an assisted living program--such as help with dressing, grooming and bathing or assistance with medications--must be provided under a Minnesota Department of Health (MDH) Class A or Class F home care license issued by the Minnesota Department of Health (MDH). MDH regulates and surveys home care providers. The license requirements spell out the services the agency is allowed to provide and all of the staff training, supervision and other requirements that the agency must follow.

Minnesota requires that a registered nurse (RN) must assess a client's needs and develop a home care service plan or agreement before staff provide any nursing services. The service plan describes all of the home care services to be provided, what they will cost and other important information. Assisted living providers are required to offer to have the RN do an assessment and develop a proposed service plan before the consumer makes a final decision about moving to an assisted living community. If you are considering an assisted living program, it's a good idea, if time and circumstances permit, to have this assessment completed before signing a residency agreement so that you have as much information as possible before making any final decisions. You can also request an assessment from your county's Long-Term Care Consultation staff.

If you receive home care services, the Minnesota Home Care Bill of Rights lists specific rights that you have as a consumer, such as:

• The right to choose your home care provider, within limits of insurance or financial assistance programs;

• The right to take an active part in developing your service plan;
• The right to know the charges for the services, and more.

Your home care provider will give you a copy of the Bill of Rights. In addition to the list of rights you have, the Bill of Rights includes information on how to contact the Office of Health Facility Complaints and the Office of Ombudsman for Older Minnesotans if you should have a complaint about your services. In addition to Minnesota's assisted living and home care requirements, home care providers must comply with other state and federal laws:

• If the home care agency is Medicare-certified, it must comply with federal Medicare requirements in addition to state licensing requirements.
• Registered nurses (RNs) and licensed practical nurses (LPNs) who provide nursing services and have supervisory and other responsibilities in home care agencies must comply with the Nurse Practice Act, monitored by the Minnesota Board of Nursing.

Other services that are part of an assisted living program and other staff working in these programs may be covered by other state license requirements. Social workers, van drivers and even barbers and beauticians must be appropriately licensed by the state.

Other Protections for Seniors in These Settings
Minnesota's Vulnerable Adult Act (VAA) provides important protections for adults who may be unable to provide for their basic care without assistance and who may not be able to protect themselves from maltreatment. The VAA requires certain professionals, such as home care staff and social workers, to report suspected maltreatment to the designated county agency for investigation. Consumers also may make VAA reports.

Other consumer protection laws include state laws dealing with "truth in advertising" and laws requiring criminal background checks on home care workers and certain housing staff.

Some seniors may want to identify a family member or other trusted person to help them make decisions about their services, where to live and their finances. This can be done informally, or you can work with an attorney and use a formal legal process to give someone you trust specific legal powers, such as a power of attorney. Under Minnesota's law for advance directives for health care, you can spell out the health care services you want or don't want, and can designate a "health care agent" to make decisions if you are not able.

Where to Get More Information or Assistance
Many resources are available to assist seniors in getting information about service options, obtaining needed services or enforcing their rights:

• If you need help in determining what services you need, where you can obtain these services, or help in paying for rent or services, call Senior LinkAge Line toll free at 1-800-333-2433. Senior LinkAge Line may direct you to your county's Long-Term Care Consultation staff for more specific assistance.
• The housing manager, nurse, social worker or other staff in your building may be able to help you access information or additional services that you need. If you have a concern or problem with your assisted living services, ask the housing manager or other designated housing staff member for assistance. Both your housing provider and your home care service provider must provide you with written information about their process for handling and resolving complaints.
• The Minnesota Office of Ombudsman for Long-Term Care can provide information about your rights and can act as an advocate for older persons. This office may be contacted toll free at 1-800-657-3591.
• Consumers with concerns about the services provided by a home care provider or assisted living program may also contact MDH's Office of Health Facility Complaints toll free at 1-800-369-7994.

Source: Aging Services of Minnesota