Assisted Living Resources & FAQs - Minnesota Department of Health

Assisted Living Resources & Frequently-Asked Questions (FAQs)

Application Process

All information related to the application process is available on the Application Materials page.

Assisted Living Contract

An "assisted living contract" means the legal agreement between a resident and an assisted living facility for housing and, if applicable, assisted living services.

The contract should include:

  • terms concerning provisions of housing
  • assisted living services
  • a service plan, if applicable
Related Statutes: 144G.08 Subd. 5, 144G.50

Refer to the above from statute 144G.50 for the required items of am assisted living contract.

No. Each provider will be responsible for crafting their own contract will all the required elements.

Yes. They will sign the assisted living contract for the housing piece. A service agreement may be added later as needed.

Yes. Please refer to the definition of resident in statute 144G.09, Subd. 59. A resident will have a contract for housing at the very least.

It is not required by the 144G law for providers to include that. There is, however, a statute (256.975) under the Minnesota Board on Aging that requires prospective residents to call the Senior Linkage Line (SLL) prior to making a “long term care” choice. MDH will have some language on the Disclosure of Services checklist for consumers to be made aware of this. The current statute is being updated to reflect the new license changes for August 1st, so this will continue when the assisted living licenses are in place. Therefore, providers should inform prospective residents that they need to call the SLL before they sign a lease and be offered objective counseling and support to make an informed decision. 

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Campus Definition

The definition for a campus is contained in the 7th Special Session language under 144G.08 Subd. 4a: "Assisted living facility campus" or "campus" means:

  1. a single building having two or more addresses, located on the same property with a single property identification number;
  2. two or more buildings, each with a separate address, located on the same property with a single property identification number; or
  3. two or more buildings at different addresses, located on properties with different property identification numbers, that share a portion of a legal property boundary.
Related Statutes: 144G.08 Subd. 4a

No. You can hold an assisted living license in one building and an assisted living with dementia care for another one.

Yes, unless you meet the campus definition as above.

No. Per definition you will be required to license each of these entities separately.

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Comprehensive Homecare

A 144A comprehensive homecare license will allow you to continue to provide homecare services in the community after August 1, 2021.

Related Statutes: 144A.43 to 144A.49

No. You will no longer be required to hold the 144A comprehensive homecare license if you will only be providing care in the assisted living facility. You will, however, be required to keep a 144A homecare license in order to provide homecare services in the community.

Based on 144G.191 Subd. 3, comprehensive home care providers that do not intend to provide home care services under chapter 144A on or after August 1, 2021, shall be issued a comprehensive home care license for a prorated license period upon renewal, effective for license renewals beginning on or after September 1, 2020. The prorated license period shall be effective from the provider's current comprehensive home care license renewal date through July 31, 2021.

No. The comprehensive homecare license will continue to renew on the current yearly date it expires. The assisted living license will be valid for one year at which time an assigned renewal month will be assigned to the licensee for a prorated renewal rate at the first renewal period.

Yes, it will be to private pay individuals. Medicare-certified homecare providers can provide skilled nurse visits to clients on medical assistance.

The Department of Human Services requires clients who receive waivered services under EW (Elderly Waiver), Community Access for Disability Inclusion (CADI), and Brain Injury (BI) to be served under the assisted living licensure.

You can serve clients in their homes that require non-Medicare-certified homecare services.

The re-opening is yet unclear. However, when it does, it will be only for those who wish to continue to provide comprehensive homecare services under 144A in the community.

If the licensee has not provided services yet and does not intend to use the 144A license after August 1, 2021, then yes, they can essentially “withdraw” their T-Comp license and receive a refund. If they later choose to apply for the 144G as a provisional license applicant, they can. T-Comp providers are not eligible for conversion.

No, there is no "waiver." You will need to renew and have a current license to either convert, change ownership, or continue providing home care services after the license expiration date. However, your 144A homecare license will be prorated if you will not continue to use it after August 1, 2021.

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Dementia Care Training

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. The persons providing or overseeing staff training are required per statute to have experience and knowledge in the care of individuals with dementia, including:

  • two years of work experience related to Alzheimer's disease or other dementias, or in health care, gerontology, or another related field; and
  • completion of training equivalent to the requirements in this section and successfully passing a skills competency or knowledge test required by the commissioner per 144G.83 Subd. 3(2).

Related Statutes: 144G.83

Per 144G.83 Subd. 3 anyone providing or overseeing staff training pertaining to dementia care must pass a skills competency or knowledge test required by the commissioner. MDH recommends the essentiALZ® Exam from Alzheimer’s Association.

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Housing with Services (HWS)

As of August 1, 2021, Housing with Services (HWS) establishments statutes will be repealed. HWS registrations will no longer be valid.

If you are registered as an HWS establishment under chapter 144D and you are providing home care services or have contracted with a home care provider providing services to at least one resident and you intend to provide assisted living services on or after August 1, 2021, you must apply for an assisted living facility license no later than June 1, 2021.

If you do not intend to convert to an assisted living facility license, you must provide written notice to your resident(s) at least 60 days before the expiration of your registration, or no later than May 31, 2021, whichever is earlier.

  • Please see Minn. Stat. § 144G.191, subd. 4(b)(1)-(5) for the specific information you must include in the notice.
  • All registered HWS establishments providing assisted living services must have an assisted living license effective August 1, 2021.
  • All HWS establishments that have not converted to an assisted living license are prohibited from providing assisted living services effective August 1, 2021.
Related Statutes: 144D Minn. Stat. § 144G.191, subd. 4(b)(1)-(5) 144G.08 Subd. 68

Yes, that is correct. In response to the question about Housing for Older Persons Act (HOPA), the department does not have jurisdiction over this and refers you to DHS or Hud.gov to answer the question.

Email your concern or questions to health.hws@state.mn.us.

Yes, if the tenants are not being served under the customized living services with payments under Elderly Waiver (EW), Community Access for Disability Inclusion (CADI), or Brain Injury (BI) waivers. Nor can the entity promote or advertise as an assisted living facility. It will simply be an apartment building under landlord/tenant law.

Yes, they will be an apartment building, marketing to seniors. If meals are provided, they would need a food license. They cannot provide any health-related services, only supportive services.

"Supportive services" means:

  • assistance with laundry, shopping, and household chores;
  • housekeeping services;
  • provision or assistance with meals or food preparation;
  • help with arranging for, or arranging transportation to, medical, social, recreational, personal, or social services appointments;
  • provision of social or recreational services; or
  • "I'm okay" check services.

No. Registrations will be processed until June 1, 2021. For more infomation, contact health.HWS@state.mn.us

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Licensed Assistant Living Director (LALD)

All licensed assisted living facilities require a Licensed Assistant Living Director (LALD). Qualified individuals have until June 30, 2021 for licensure under one of five "grandfathered" legacy pathways. Individuals who do not qualify under a legacy pathway must meet the new LALD requirements. Requirements can be found at the BELTSS Assisted Living Director website. Any questions regarding the licensed assisted living director can be emailed directly to beltss.hlb@state.mn.us.

Related Statutes: 144G.08 Subd. 6 144G.12 Subd. 1 (2), (13), and (14) 144G.82 Subd. 2

Yes, each Minnesota licensed assisted living facility must employ an assisted living director licensed by the Minnesota Board of Executives for Long Term Services and Supports (BELTSS) under Minn. Stat. 144G.08 Subd. 6. Under Minn. Stat. 144G.10 Subd. 1a, each assisted living facility must employ an assisted living director licensed or permitted by the BELTSS.

All health care professional licenses indicate that a credential holder has met the minimum knowledge, skills, and abilities of an entry level practitioner. The legislature establishes those minimums in statute and rules are created by the assigned agency to provide greater detail to the law’s framework. A Registered Nurse, Medical Doctor, Social Worker, Alcohol Drug Counselor, plus 13 other professions in Minnesota, have met the minimum education and prior experience requirements to obtain a professional individual license. The ongoing practice standards are established by the Professional Practice Analysis of the National Association of Long Term Care Administrator Boards (NAB) every five years to assure a contemporary community standard developed from a practitioner perspective.

The BELTSS is targeting no later than May 1, 2021, for the online applicant portal to accept applications. All legacy applicants must be submitted no later than June 30, at 11:59 p.m. Supporting items do not need to be completed by that date. The criminal background check process can take 30-45 days from the date the applicant completes their fingerprinting.

Once all items are received, the BELTSS can issue a license within 48 hours. Applicants can monitor the progress of their application on the licensee portal. The license is valid once electronically issued and can be searched on the BELTSS website. The licensee Lookup provides an official license number, name, and a time stamp from the board as to its authenticity. The wall certificate to display your license is mailed within 3-5 work days to the address listed on the licensee portal. The wall certificate is expected to be posted for consumers, staff, and families in a common area.

Addendum: BELTSS will begin accepting applications as of April 19, 2021.

The statute directed five unique, different pathways for legacy or grandfathering. Just one of those five pathways are required to meet the initial requirements for licensure. Requirements can be found at the BELTSS Assisted Living Director website.

Leadership of organizations and management of daily operations continues to evolve. BELTSS intentionally does not identify a minimum number of hours for the Licensed Assisted Living Director but expects that the LALD has assessed how to communicate, interact, monitor for quality control, delegate, investigate, monitor safety and environment controls while being the Director of Record.

Yes. The individual would be required to possess both licenses.

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License Fees

The fee structure for the new license will be:

  • Assisted Living Facility License: $2,000 plus $75 per planned resident capacity.
  • Assisted Living Facility with Dementia Care License: $3,000 plus $100 per planned resident capacity.
Related Statutes: 144G.12 144.122

It is the number of residents a facility chooses to be licensed for. Please refer to the definition of "resident." "Resident" means a person living in an assisted living facility who has executed an assisted living contract (related statute: 144G.08 Subd. 59). Therefore, any individual residing in the facility will be counted in the planned resident capacity.

Facilities are required to license to the highest denominator as there is only one license allowed per building. In this scenario, the building would be required to hold the assisted living with dementia care license. Referring to the top then, the fee would be the $3,000 plus $100 per planned resident capacity.

Current comprehensive home care providers who do not intend to provide home care services under 144A on or after August 1, 2021:

  • Shall be issued a comprehensive home care license for a prorated license period upon renewal, effective for license renewals beginning on or after September 1, 2020.
  • The prorated license period shall be effective from the provider’s current comprehensive home care license renewal date through July 31, 2021.
  • Comprehensive home care providers with prorated license periods shall pay a prorated fee based on the number of months the comprehensive home care license was in effect.
  • Comprehensive home care providers using the prorated license or who otherwise do not intend to provide home care services after August 1, 2021, must notify the recipients of changes to their home care services in writing at least 60 days before the expiration of the provider’s home care license, or no later than May 31, 2021, whichever is earlier.
Please see Minn. Stat. § 144G.191, Subd. 3(c)(1)-(5) for the specific information you must include in the notice.

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License Options

There are two license options for assisted living facilities:

  • Assisted living facility (144g.08 Subd. 7): a licensed facility that provides sleeping accommodations and assisted living services to one or more adults.
  • Assisted living facility with dementia care (144G.08 Subd. 8): 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.
Related Statute: 144G.80-84

Yes. You can apply for the assisted living license for the HWS building. As stated, the "unlicensed" building will be just that, an apartment building. Any of the tenants of that building are free to choose whichever 144A comprehensive homecare provider they wish.

In statute definition 144G.08 Subd. 8, "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.

If you do not plan to market or promote providing specialized care for dementia, and will not have a secured unit, then you will apply for the Assisted Living License. If your "dementia unit" is secured in any way, then the entire building will need to be licensed as an Assisted Living with Dementia Care license.

Facilities are required to license to the highest denominator as there is only one license allowed per building. In this scenario, the building would be required to hold the assisted living with dementia Care license.

In statute definition 144G.08 Subd. 8: "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.

In statute definition 144G.08 Subd. 62: "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.

In conclusion, if the 4–5-bedroom house meets the above two definitions, then yes. The determining factor is, does the resident have the freedom to leave the "unit" of their own volition.

In statute definition 144G.08 Subd. 62: "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.

Please use the definition to determine the unique specifications for your facility.

In statute definition 144G.08 Subd. 8: "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.

Based on the above definition, if the plan is to market the facility as "providing specialized care for individuals" with dementias, then yes.

The new assisted living licensure law impacts all customized living services funded by Elderly Waiver (EW), Brain Injury Waiver (BI) and Community Access for Disability Inclusion (CADI) Waivers. If you want to continue to receive payment, you must be licensed as an assisted living facility.

If you have questions for the Department of Human Services (DHS) regarding customized living services provider enrollment, please contact Samuel Acquaah at samuel.acquaah@state.mn.us.

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Meals and Dietary Requirements

Providers must offer to provide (or make available) the following services to residents:

  • At least three nutritious meals daily with snacks available seven days per week
  • Seasonal fresh fruit and fresh vegetables
  • Menus must be prepared at least one week in advance
  • Meals prepared according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines
  • Meal substitutions must be of similar nutritional value
  • Residents must be informed in advance of menu changes
  • Food must be prepared and served according to the Minnesota Food Code
Providers cannot require a resident to include and pay for meals in their contract (if they do not want to purchase them).

Related Statutes: 144G.41 Subd. 1 (13); Minnesota Food Code, Minnesota Rules, Chapter 4626

Statute indicates all assisted living facilities shall offer to provide or make available at least three nutritious meals daily. As a provider you are required to have the availability to provide at least three meals per day. The provider cannot have a blanket "one size fits all" meal charge.

Statute indicates all assisted living facilities shall offer to provide or make available at least three nutritious meals daily. There is no language that indicates where the meals should be served.

Statute indicates all assisted living facilities shall offer to provide or make available at least three nutritious meals daily. Using "Mom’s Meals" would meet the "make available" option, but will not negate the menu requirement, nor the seasonal fresh fruit and vegetable requirement. A provider would still be responsible to ensure the entire statute is met.

MDH is currently working on the plan/process for review. Whomever is currently doing plan review, inspections, and surveys will continue to do it until an organized, thoughtful transition can occur between Health Regulation Division and Food, Pools and Lodging at MDH. At that point, guidance will be given on how plan review, inspections, and surveys may or may not change.

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Physical Environment

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.

Related Statutes: 144G.45 144G.81 Subd. 1, 2, & 3

Fire protection for assisted living facilities must be met per 144G.45 Subd. 2, as amended. This subdivision does not reference a sprinkler mandate. However, the assisted living with dementia care license requires the building to be sprinklered by August 2029 (144G.81 Subd. 1 (2)). Please keep in mind that you must stay in compliance with all other local or state codes and standards.

A submittal of construction documents or an architectural floor plan and associated documents for plan review and inspection will not be required for initial conversion.

Any conversion facilities with construction projects beginning on or after August 1, 2021, will need to submit construction documents (new construction) or an architectural floor plan (existing building with any areas not undergoing construction) and associated documents for plan review and inspection.

In December of 2020, the legislature passed an amendment to 144G.45 Subd. 2, a law that added clarity to the assisted living licensure law that originally passed in the spring of 2019. This law defines the design requirements for assisted living construction. If the construction project applies for a building permit prior to August 1, 2021, then that project needs to comply with the construction requirements at that time, the 2020 Minnesota State Building Codes. If a construction project applies for a building permit on August 1 or later, the project must comply with the 2020 Minnesota State Building Codes and the design requirements in 144G (Life Safety Code and Facility Guidelines Institute).

The law requires the inclusion of at least one bath to allow residents the option of a bath. One possible design option would be to have a central bath that all residents are able to use. This requirement is in a subdivision for new construction or new licenses. It would not require a bath to be installed in a Housing with Services (HWS) that converts to assisted living. Refer to statute 144G.45 Subd. 4 for more information.

Most (small) facilities do not have an extinguishing or alarm system and would not be expected to install a system to meet this requirement. If you do have one of those systems (larger facility), a general requirement of the Minnesota Fire Code is a backup system, and that system is usually a battery backup. A battery backup system meets this emergency preparedness requirement.

A generator is generally not required in any assisted living facility. Generators are usually installed when a loss of power would cause major injury or death. If your emergency plan calls for a generator, then that generator must be installed, maintained, and tested in accordance with codes.

No. If you have a fire alarm system and/or emergency lighting, then you most likely have a battery backup system in accordance with the Minnesota Fire Code. Typically, facilities with 1-5 residents (usually single-family home) or 6-16 residents (usually duplex, triplex or fourplex) do not have emergency lighting and would not require an alternate source of energy to maintain that system in the event of a power outage. If you have a generator then you must maintain, inspect, and test it in accordance with all codes and standards.

You need a plan to deal with a power outage if you have some sort of sewage pump that requires electricity. Some facilities may have toilets that flush and then are pumped to the sanitary sewer or septic system. These types of systems must have backup power. In most cases, the backup power used for this is battery.

The statute does not specify that a facility must have a generator that would support the operations of a “whole building.” The generator (if installed or required by the facility) must serve the building as described in the emergency plan. Portable generators may meet those requirements if written into the emergency plan.

Fire drills and staff training must comply with 144G.45 Subd. 2, as amended, and should be documented in the facility’s standard operating procedures. Staff training for fire drills and performing fire drills are two different things. Staff must be trained as indicated in statute and the fire drill requirements test the staff training. Staff will evaluate their performance on fire drills and update their training based on performance on the drills.

The law does not require a Fire Marshal to participate in assisted living facility fire drills. MDH recommends involving the local fire department, fire chief and or state fire marshal with fire drill planning. MDH believes it is very beneficial to introduce the responding fire official to your building.

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Staffing

All assisted living facilities must have a clinical nurse supervisor who is a registered nurse licensed in Minnesota. The positions of both the assisted living director and the clinical nurse supervisor may be held by the same individual if the individual holds both licenses.

The staffing plan must be evaluated at least twice per year and include sufficient staffing at all times to meet the scheduled and reasonably foreseeable needs of each resident

A 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.

Related Statutes: 144G.41 Subd. 1 (11-12) 144G.81 Subd. 4 144G.83 Subd. 1 (c) 144G.41 Subd. 12.1 144G.70 144G.81 Subd. 4

Under the statute it does NOT give staff ratios that the facility must follow. They must be able to satisfy the requirement to meet the scheduled and reasonably foreseeable needs of each resident.

Statute does not address whether a nurse can have more than one place of employment. Statute does address a nurse and the services provided must comply with the Nurse Practice Act in 148.71 to 148.285. Statute also defines a clinical nurse supervisor as a Registered Nurse (RN) licensed in Minnesota. The statute dictates certain duties that must be completed by the RN:

  • Resident assessments
  • Delegation of nursing tasks
  • Training and competency testing of unlicensed personnel
  • Be available for consultation to staff performing delegated nursing tasks (either in person, by telephone, or by other means)
  • Supervision of staff based on statute requirements in 144G.62 Subd. 4
  • Certain policy development

Statute does not address whether unlicensed personnel can have more than one place of employment. If the “organization” is the “W-2 holder” and is responsible for the provision of such staff across several locations, the “organization’s” requirement is to ensure adequate staffing at all its facilities.

For assisted living licensure, under 144G.41, subdivision 1 (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:

  • awake;
  • 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;
  • capable of communicating with residents;
  • capable of providing or summoning the appropriate assistance; and
  • capable of following directions.
So at an assisted living licensed entity, the staff must be awake, however one staff member could be responsible for covering more than one unit.

For an assisted living with dementia care license, under 144G.81 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 Subd. 1, clause (12).

None. See 144G.41 Subd. 1 (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:

  1. awake;
  2. 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…”
A nurse who is not on site but is available for consultation to staff performing delegated nursing tasks (either in person, by telephone, or by other means), may be asleep (at home) if the nurse is able to respond accordingly when summoned.

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Survey Process

The MN Department of Health (MDH) is the exclusive state agency charged with the responsibility and duty of surveying and investigating all facilities required to be licensed under Minnesota Statutes, chapter 144G. The commissioner shall conduct a survey of each assisted living facility on a frequency of at least once every two years. Surveys and investigations shall be conducted without advance notice to the facilities.

Related Statutes: 144G.16 Subd. 2 144G.19 Subd. 3 144G.30

Providers who are “converting” must already be serving at least one client. They all start over with August 1, 2021 being day one. They could be surveyed at any time over the next two years.

For a conversion licensee, it will be anytime within two years from August 1, 2021. For a provisional applicant, it will be within one year of notifying the department they are providing services to a resident.

Immediately upon the new Assisted Living Licensure becoming effective on Aug. 1, 2021.

Much the same as it has been like for the homecare surveys under 144A. MDH is currently developing survey documents for survey licensure which will be shared upon completion.

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Updated Friday, 07-May-2021 12:19:34 CDT