A hard-won consensus on elder care in Minnesota

May 15--Minnesotans with aging loved ones owe a debt of gratitude to the senior citizen advocates, long-term care providers and state health officials who labored late into the night last weekend to finalize a landmark deal to modernize the state’s elder care regulations. Lawmakers now need to honor this hard work, which means hustling to put the agreement’s language into legislation, passing it and robustly funding it in the dwindling days before the session expires on Monday.

A 2017 Star Tribune series spotlighting shocking abuses in care facilities and inadequate investigation of complaints made clear the need for reforms and, in 2018, legislators took a run at this. One of the main pushes: requiring the state’s growing numbers of assisted-living facilities to be licensed, as every other state does. While Minnesota health officials rapidly improved their handling of complaints after the series, the broader task of passing legislation to strengthen long-term care protections didn’t get done. Instead, reforms fell victim to end-of-session gamesmanship and friction between care providers and consumer advocates.

A year ago, a frustrated Star Tribune Editorial Board called on state officials and the elder care community to move forward anyway and tee up reforms for 2019. It is a credit to advocates and its providers that they pushed ahead, with state Department of Health Commissioner Jan Malcolm meriting praise for shepherding the process along. Meetings continued throughout the year, yielding agreement not only on an assisted-living licensing framework but other reforms. They included dementia care standards and staff training requirements, stronger disclosure for what services are available at facilities, and speeding up health officials’ ability to impose fines for serious violations.

But sticking points remained up through last weekend, with key disagreements on how to protect residents in the event of a housing or service termination, guard against “retaliation” if abuse or theft is reported and what interim safeguards to put in place until assisted-living facility licensure would take effect in 2021. The lack of consensus had the potential to hinder this year’s long-term care bills at the Capitol. It’s far easier for lawmakers to enact a reform package when stakeholders are in agreement than when their lobbyists continue to press individual legislators for advantage. Consensus also suggests the reforms merit the investment of taxpayer dollars.

Realizing that, care providers and consumer advocates sacrificed one of this spring’s first sunny weekends to gather in a windowless conference room at the Department of Health. In a Saturday meeting that didn’t end until early Sunday morning, the group found a way to resolve differences. Agreement was hammered out on interim safeguards and other measures, with each side emerging bleary-eyed and feeling like they’d given up a lot but also found comfortable common ground. “We didn’t get everything we wanted. Industry didn’t get everything they wanted. And that’s what compromise is,” said Mary Jo George of AARP Minnesota.

That work now allows consumer advocates and long-term care providers to send this unified message to legislators: Seize the momentum and pass the reforms this year. Fortunately, the measures have influential champions in both chambers. Rep. Jennifer Schultz, DFL-Duluth, has already guided a strong reform package through the House. Sen. Karin Housley, R-St. Mary’s Point, has taken the lead in her chamber. Updating these efforts with the language hammered out over the weekend will be a heavy lift with only a few days remaining in the session. Still, it’s doable.

The surest route to enactment is to have the reforms travel as stand-alone legislation instead of folding them into a sprawling omnibus bill that runs a veto risk as budget battles escalate. “Don’t bring seniors into the negotiations room,” Housley wisely said.

The reforms also need adequate funding. Implementing the new regulatory framework while continuing to strengthen agency oversight is a massive undertaking and will take resources. The amount proposed by Gov. Tim Walz’s budget -- around $32 million over the biennium -- is a realistic sum to make this happen in the manner and swift time frame that Minnesota seniors deserve. “Lawmakers can’t beat up the government for not doing its job but then starve it of the resources it needs,” said AARP’s George. “You can’t have it both ways.”

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