SF4121

Purpose

This bill aims to update and strengthen policies, procedures, and training in Minnesota assisted living facilities. It focuses on resident rights, safety, staffing, and the oversight of health care activities provided by staff who are not licensed, with closer alignment to the Nurse Practice Act and the requirements already in place for these facilities.

Main provisions

• Penalties and enforcement

  • The commissioner may assess investigation-related costs as penalties and may raise fines if a violation causes serious injury or death and the conduct is egregious.

• Minimum requirements for assisted living facilities

  • Distribute the assisted living bill of rights to residents.
  • Provide services in a manner that complies with the Nurse Practice Act.
  • Maintain a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of those delegated activities.
  • Use a person-centered planning and service delivery process.
  • Ensure access to health and safety assistance 24/7; have a system for residents to request help at any time.
  • Allow residents to decorate their units, access food at any time, and choose visitors and visiting times.
  • Allow residents to choose a roommate if sharing a unit.
  • Provide lockable doors to residents’ units, with locks supplied by the facility; only staff with a clear need may enter, with advance notice whenever possible; residents must not be locked in.
  • Develop and implement a staffing plan that annually evaluates staffing levels, ensures enough staff to meet resident needs 24/7, and enables prompt response to emergencies.
  • Ensure one or more persons are available 24/7 to respond to resident requests for health or safety assistance; such persons must be awake, located nearby, capable of communicating with residents, and able to provide or summon needed help.
  • Provide staff access to an on-call registered nurse 24/7.
  • Create a plan to immediately attend to resident needs in emergencies and have a person trained in emergency response on site 24/7.

• Policies and procedures

  • Facilities must have policies addressing: maltreatment of vulnerable adults reporting; background studies on employees; orientation, training, and competency evaluations; handling complaints; initial and ongoing resident evaluations and needs assessments; how changes in a resident’s condition are identified, managed, and communicated; orientation to the assisted living bill of rights; infection control; reminders for medications and treatments; screenings to show staff are free of tuberculosis per CDC standards; licensure status of nurses and other licensed health professionals; delegation and supervision of tasks by licensed professionals; emergency procedures.
  • Policies and procedures must be kept current and available to residents or their representatives; emergency policy materials must be provided to prospective residents before admission and to current residents at nursing assessments.

• Training and evaluation of unlicensed personnel

  • Training must cover: documentation requirements for provided services, reporting changes in resident condition, infection control, clean and safe environments, personal hygiene and grooming, care of hearing aids, door locks, fall prevention, standby assistance techniques, reminders for medications/exercises/treatments, basic nutrition and modified diets, communication that preserves resident dignity and respects preferences and privacy, confidentiality and privacy, boundaries with residents and families, emergency procedures, and familiarity with health technology and assistive devices.
  • Additional training components include: observing and reporting resident status; knowledge of body functioning and changes; measuring and recording temperature, pulse, and respiration; recognizing physical, emotional, and other needs; safe transfer techniques and ambulation; range of motion and positioning; and administering medications or treatments as required.

Significant changes to existing law

• Stronger enforcement and penalties for violations, including ability to recover investigation costs and higher fines for egregious conduct causing serious harm.
• Expanded resident autonomy and rights within facilities, including 24/7 access to assistance, the ability to decorate units, ownership of lockable doors, and control over visitors and roommates (within policy).
• Increased staffing and supervision requirements, including a formal staffing plan with biannual evaluations, guaranteed 24/7 on-site and on-call coverage, and clearly defined response roles for emergencies.
• Expanded and standardized training for unlicensed personnel, with comprehensive content on safety, health changes, documentation, infection control, medication support, nutrition, emergency procedures, and preserving resident dignity.

Relevant Terms assisted living facilities; unlicensed personnel; registered nurse; Nurse Practice Act; assisted living bill of rights; maltreatment of vulnerable adults; background studies; infection control; tuberculosis (TB) screening; Centers for Disease Control and Prevention (CDC) standards; on-call registered nurse; 24 hours per day seven days per week; emergency procedures; standby assistance; delegation and supervision; residential lockable doors; resident rights; roomate selection; health and safety assistance; staffing plan; resident evaluations; emergency response on-site staff.