Small adult daycare providers accuse DHS of treating them like criminals 

Operators of small adult daycare and assisted living centers — many owned by immigrants and people of color — accused the state Department of Human Services of targeting them with onerous new licensing regulations during a recent Senate committee hearing.

Senators seemed sympathetic, and legislation could be coming. 

The providers were required to transition to assisted living licensure and say the state is burdening them with new requirements that make it difficult to stay in business. State officials say they’re just complying with federal rules and putting safeguards in place to protect seniors and people with disabilities.

The owner of an adult day center told the Senate Human Services Committee that some state employees treat them like criminals.

Fartun Weli has owned a small adult day center called Peace of Mind since 2018, and said the DHS “Waiver Reimagine” program has been a nightmare for small providers. Weli broke down, saying she’s been on sleeping pills since August due to the stress of complying with new state requirements.

DHS says the program overhaul is intended to simplify and create more options for seniors and people with disabilities who use what are known as waivers, or federally funded programs that help people live in the community rather than an institution.

The conflict highlights the coming tension as the state tries to build out a flexible care infrastructure for a rapidly aging population. 

DHS Assistant Commissioner Natasha Merz said in an interview that the department is in the second phase of modernizing and streamlining the waiver program, while complying with new federal requirements.  

A group of small, assisted living centers with home care licenses that provide services — some of them culturally specific or serving people of color or the immigrant refugee community — have been affected by the changes.

Previously, the state didn’t have the right regulatory structure to protect seniors, Merz said, and some providers were providing too few or too many services to people. 

“There was no regulatory mechanism for the providers that weren’t doing what they needed to do,” Merz said.

State lawmakers passed legislation to begin licensing assisted living centers after horror stories emerged of seniors beaten, robbed and sexually assaulted at previously unregulated assisted living centers. 

They are now regulated by the state health department, which can take action if a provider doesn’t meet basic health and safety standards. 

The Legislature passed rate limits in 2019 because spending in the customized living program was much higher than expected — $114 million higher than forecast. So providers like Weli had to get into compliance with the licensing statutes, even as their rates were cut by the Legislature.

“They’re understandably feeling very squeezed between two systems,” Merz said. “And so I completely understand how challenging it’s been for small assisted living providers.”

The assisted living license wasn’t necessarily designed to support a small business; it was designed to support a typical building with 100 to 200 units, she said. So the providers went through “hard and expensive” licensing changes, and then the department asked them to switch to different service models — which has been a difficult transition for providers.

Weli said the state is requiring providers like her to separate people by age and disability — rather than mixing senior citizens with young people, for example — even though she has a 4,000-square-foot building.

“Everyone wants to be independent and our job is to keep people healthy and social, but when they’re isolated into age group, disability group, they deteriorate,” Weli said in an interview after the hearing. “All the research, all the data shows that.”

She said she’s hired consultants to help her deal with numerous citations — all administrative issues, not fraud or abuse — and hired people to do paperwork.

“We went through 18 reams of paper,” she said.

Some of her colleagues were going to testify, but didn’t out of fear of retaliation, Weli said. One of them wrote a letter to the committee anonymously, out of fear DHS would retaliate.

Amal Ahmed, a nurse and board member of Residential Providers of Minnesota, said the group formed in response to massive changes to regulations.

She said culturally competent minority providers have been “generally boxed out” by the state, even though the state’s BIPOC population has increased.

Mary Turner, president of the Minnesota Nurses Association, told lawmakers more culturally competent care would help ease backed-up emergency rooms like the one she works in at North Memorial in Robbinsdale.

“The bottleneck is becoming unsustainable in my world,” she said.

The committee chair, Sen. John Hoffman, DFL-Champlin, said his colleague Sen. Omar Fateh, DFL-Minneapolis, was asked to research community concerns two years ago. 

Hoffman noted the majority of providers affected are people of color, “So it’s like, OK what’s going on here?”

“I think this is the year to fix it right now,” he said, indicating legislation may be imminent.

DHS is working with Residential Providers of Minnesota, which represents small, mostly minority-owned residential living providers, to address their concerns and provide technical assistance on legislative changes they want, Merz said.

“We really do want our culturally proficient providers… providers that are serving BIPOC communities, to be successful and to thrive in Minnesota,” Merz said. “But I understand completely their perspective that they feel like everything that’s happening to them right now is not fair.”