MINNESOTA'S HOUSING-WITH-SERVICES CONTRACT ACT
The Minnesota Health & Housing Alliance developed the Housing-with-Services Contract Act to create a new model for quality assurance in residential settings serving frail seniors. In looking at how to provide the necessary consumer safeguards for assisted living, MHHA's research showed widespread consensus that neither consumers nor providers wanted to impose an institutional, nursing-home style regulatory system on Minnesota's assisted living communities. Much of assisted living's popularity with consumers stems primarily from the fact that it has an emphasis on independence, choice, flexibility and individualized services.
Thus, the quality assurance model created by the Housing-with-Services Contract Act, passed in 1995 and effective in 1996, takes a consumer-driven approach. It uses contracts between the housing provider and the consumer or resident as the primary mechanism for quality assurance. Through the process of reviewing the information in the contract and negotiating any items that may vary from one resident to another, consumers are provided the information they need to make informed decisions about where they want to live and the services they choose to use. Once the housing contract is signed, the consumer has a legal document that sets out standards for the housing-with-services provider and, if necessary, can use the legal system if the provider fails to meet those promised standards.
In Minnesota's system, if the resident wants to obtain health-related services from a home care agency, the resident has a separate contract with important information, such as the services that will be provided, the cost of the services, which staff will provide the services, who will supervise the services and how often. The owner of the residential building may carry a home care license, or home care services may be available from a separate organization. Either way, residents will have the opportunity to work with the home care staff to negotiate and plan their services.
While the overall quality assurance mechanism for housing-with-services is under the control of the resident, the Minnesota Department of Health (MDH) does step in to regulate and inspect health-related (home care) services. In addition, MDH has the authority to intervene if it appears that a building is out of compliance with the Contract Act or Minnesota's 2006 assisted living law. There are other laws and government agencies with an interest in the wellbeing of housing-with-services residents. These include the Vulnerable Adult Act, Tenant-Landlord law, fire and building codes, and others.
Unlike other states, Minnesota neither requires housing-with-services establishments to conform to specific physical plan specifications, nor does it mandate a specific package of services that can be provided. As long as building code and occupancy requirements are met, buildings may serve as few as five residents in a small, home-like setting; may offer private or shared sleeping rooms in settings where all meals are provided in a congregate dining area; or may serve hundreds of residents living in private apartments. Providers are free to design their buildings, to choose from an array of possible "supportive" and "health-related" services, and to develop their own service packages based on the needs of their community and their target market. This means that a variety of options--some providing only a little assistance and some that provide very "heavy" care--are available to consumers.
In understanding all of the potential options, consumers can rely on the written contract to explain exactly what a particular setting provides and any of its specific requirements and procedures, as well as the knowledge that the state will oversee the quality of any health-related services. In addition, as part of Minnesota's assisted living law, buildings that offer assisted living services soon will be required to complete a standardized form called the Uniform Consumer Information Guide. This guide includes information that consumers can use to decide which providers they want to visit and learn more about. The standard format of the guide will enable consumers to more easily compare several different buildings and their services. Finally, the guide includes helpful information and resources about consumer rights. Assisted living providers must begin distributing the completed Uniform Consumer Information Guide by January 1, 2008, but many providers will have it available before that date.