Hidden pandemic in Minnesota’s assisted living facilities: More regulation coming, but when?

Jack Bogenreif’s daughter-in-law, Kerry, came to check on him every day while he lived in assisted living.   

"He was a lumber jack, a barber... he could sharpen anything, could fix anything, had a great sense of humor and had a passion for life," Kerry said.     

The 86-year-old Navy veteran lived at the Encore at Hugo. When COVID hit in March, their daily visits ended, breaking both their hearts.     

"He looked at me and said you are staying away on purpose and I said, ‘no I am not, but I was because I couldn’t go in because of COVID," Kerry said.    

From their window visits, she could tell Jack’s health was quickly declining and his care seemed non-existent.     

"I could see dirt on the walls, I could see his nails needed to be trimmed, I could see his beard needed trimming, and his oral care wasn’t being done, she remembered.

In September, state investigators would confirm her fears, uncovering negligence at the Encore at Hugo. There was a resident who fell twice. Another who lost 20 pounds in a month and hadn’t had a bath for three weeks. An infection control survey discovered employees weren’t being screened. Five employees got COVID, along with 16 residents and nine residents died.      

Encore did not respond to calls from the FOX 9 Investigators.  

After three months of lockdown, Jack went to the hospital for a urinary tract infection, which had developed into sepsis. He came back to Encore, only to die from COVID five days later. Jack’s story is part of a hidden pandemic.   

Seventeen percent of all those who have died from COVID in Minnesota have been in assisted living, or 829 total lives lost. 

Only skilled nursing facilities have had more deaths with 2,090.  

But unlike nursing homes, assisted living facilities are not licensed by the federal government. Minnesota is the last remaining state to not license or regulate assisted living. Currently, the state only licenses service providers, those who come in to help residents with specialized care, like bathing or housekeeping.  

In 2019, the Legislature passed sweeping changes to license assisted living facilities, but the new rules aren’t scheduled to go into effect until next summer and might even be delayed until 2022.  

And for that, we may be paying a terrible price.     

University of Minnesota Adjunct Faculty Member and Gerontologist Eilon Caspi believes the lack of staffing and regulations, on top of a pandemic, made for a worst-case scenario.  

"By and large, the assisted living sector is flying under the radar without a black box...extreme lack of transparency, there is a lot we don’t know," he said. "COVID exposed many of the systemic failures in assisted living residences across Minnesota, exacerbated the conditions and increased the risks for the vulnerable, frail population."    

To understand why, you need to know the differences between a skilled nursing home, which provides 24-7 medical care, and assisted living. 

Assisted living residents have their own apartments, allowing them to live more independently; for many it doesn’t carry the same stigma as a nursing home. There may be a licensed nurse on staff, but residents rely mostly on care attendants, who may have little to no medical training except for what they’ve received from their employers.    

It’s not cheap. According to Genworth Insurance, the average cost for assisted living in Minnesota is $3,800 a month.     

Residents with high level of needs 

Suzy Scheller is an attorney specializing in elder abuse. She believes while some seniors are healthy and independent enough for assisted living, many others have needs that are just too great, or deteriorate too quickly.    

According to the Centers for Disease Control and Prevention, 40 percent of those in assisted living have some form of dementia. State records show that more than one third of the assisted living facilities in Minnesota have a memory care unit. 

"Some would say assisted living is the new nursing home," Scheller said. "So what we are seeing is a high level of needs and care in assisted living where the consumer model doesn’t keep pace with it and we need more input and regulation a better look at what is happening in the buildings."  

The Minnesota Department of Health believes the biggest issue for assisted living is staffing.   

"There is increased staffing with the new licensure, requirements for staff to be on site based on the needs of the clients or residents that they are taking care of, said Lindsey Krueger, the Health Facilities Section Chief at the Minnesota Department of Health.    

But the reality is the industry can’t fill the positions that are open now.  

According to industry trade group, Care Providers of Minnesota, there were 7,060 unfilled caregiver positions in Minnesota’s 1,764 assisted living facilities.    

Part of the problem, experts say, may be a starting wage of $15 an hour for care attendants.  

"Behind closed doors" 

Susan Throndrud saw how bad it was before the pandemic, courtesy of a camera she installed in her 90-year-old mother’s room at the memory care unit at York Gardens in Edina. One night her mother woke up and started calling for help. After 40 minutes, she slid off the bed. An alarm on the bed failed to go off, and she spent the next hour lying on the floor crying out for help.

There were three other falls in two months, in each case the bed alarm failed. The family was paying $6,800 a month for her care. When an attendant insisted she had spent 47 minutes with her mother, Susan checked the video.  

"Thirty-one of those minutes she was on her cell phone, yelling to my mother across the room to get up," Throndrud recalled. 

"Something is fundamentally wrong with the system that allows an elderly woman, anybody, to be disregarded." Throndrud told the Fox 9 Investigators.  "Behind closed doors people just don’t see what is happening to their loved ones, it is heartbreaking," 

After Throndrud's mother fell, Ebenezer - which owns York Gardens - said they took immediate action, including "more frequent resident checks," "making technological adjustments to ensure our sensors and equipment function properly" and "additional staff training."  

Licensing coming to assisted living 

Throndrud took her mother’s case to state lawmakers, who last year passed the sweeping changes in elder care protections.    

The legislation includes: licensing all assisted living facilities, bi-annual inspections of the facilities, separate licensing for dementia units and specialized training for staff.

State Sen. Karin Housley believes the legislation was overdue.    

"I take probably two or three texts, Facebook messages a day from people who are concerned about their loved ones in long term care facilities," she said. 

The legislation will also include a consumer report card, information which select families and residents will contribute. It will allow people to compare assisted living facilities based on several quality measurements, similar to an existing system for nursing homes. Once complete, it will be available from the Minnesota Department of Human Services, via a website in 2021; a starting date has not been set.

For more information on the licensing of assisted living facilities go to the Minnesota Department of Health web site.