Assisted Living
Resources & Frequently-Asked Questions (FAQs)

All information related to the application process is available on the Application Materials page.

Assisted living contract

An "assisted living contract" means the legal agreement between a resident and an assisted living facility for housing and, if applicable, assisted living services.

The contract should include all the terms concerning the provision of:

Refer to 144G.50 for the items required in an assisted living contract.

No. Each provider will be responsible for drafting their own contract with all the required elements.

Yes. It doesn't matter if someone is receiving services or not, they are all considered residents. Please refer to the definition of resident in statute 144G.09, subdivision 59. A resident will have a contract for housing at the very least. A service agreement may be added later as needed.

Adding this information to the assisted living contract is not required per 144G. There is a statute under the Minnesota Board on Aging (256.975) that requires prospective residents to call the Senior Linkage Line (SLL) prior to making a "long term care" choice. MDH has added this language to the Uniform Disclosure of Assisted Living Services & Amenities (UDALSA) so prospective residents call the SLL before signing an assisted living contract for objective counseling and support in making an informed decision.

Yes. Assisted living contracts may include contract language to limit the licensee’s liability regarding the actions of third parties, such as third-party health care providers and resident guests.

Yes; if it is simply a recommendation only and does not indicate the licensee has no responsibility related to the personal property of the resident.

Yes; but it is not necessary. Nothing in statute indicates the licensee is liable when the resident chooses to leave the premises of their own volition.

No. The statute prohibits the contract from including a waiver of the licensee’s liability for the health, safety, and personal property of the resident, or from implying a lesser standard of care or responsibility than required by law. A section heading does not violate those provisions if the content within that section is otherwise permissible.

Yes, that is acceptable. The statute requires the contract to adhere to Minnesota law, and to applicable federal and local law, so including that requirement does not violate the prohibition on choice of law provisions within the arbitration agreement.

This is typically written as a 21-day correction period. MDH recognizes changing an assisted living contract can take longer than 21 days due to the need for legal consultation. If upon revisit to the facility the assisted living contract itself is not corrected, the surveyor will ask what steps the licensee is taking to come into compliance. Changes to the contract language are not required until resolution of the appeal supporting MDH’s determination.

MDH compliance expectations are based on Minnesota Statutes 144G so if the licensee is compliant with the statutory requirements, then MDH should find the citation is corrected.

No. This is not a statutory requirement; however, this does not preclude a licensee from having a policy.

No. Minnesota Statutes 144G does not explicitly prohibit indemnification clauses; however, assisted living contract language may not waive or shift the responsibility from the licensee for certain incidents onto the resident. Indemnification clauses that apply universally to all behavior by the resident are likely prohibited because, depending on the resident’s needs and services, the licensee may be responsible for preventing that specific behavior or outcome from occurring, or at least from negatively impacting others. An indemnification clause is only acceptable if it contains language that specifies that indemnity obligations only relate to those events for which the resident is legally responsible.

The following is an example of assisted living contract language MDH has cited and upheld in the reconsideration process as violating Minnesota Statutes 144G: “As an occupant of the Facility, Resident assumes the risk for the Resident’s own safety and for the safety of the Resident’s personal property….Resident will indemnify and hold harmless Facility, its employees and agents from and against any and all claims, actions, damages, and liability and expense in connection with the loss of life, personal injury or damage to the property, arising from or out of the use by the Resident…”

This indemnification language requires the resident to assume the risk of their own health, safety, and personal property and protects the licensee from “any and all” responsibility for the resident and the resident’s property, which would be interpreted as a waiver of liability under 144G.

As another example: “Resident will indemnify and hold harmless Facility, its employees and agents from and against any and all claims, actions, damages, and liability and expense in connection with loss of life, personal injury or damage to property, arising from or out of the use by Resident or Resident’s guests of the Apartment or any other part of Facility, or caused wholly or in part by an action or omission of Resident or Resident’s guests or agents.” “Hold harmless” means to excuse from liability.

The statute requires no waiver of liability or provisions that imply a lesser standard of care of responsibility than is required by law. An assisted living contract may include language indicating that intentional, negligent or careless acts of residents or their guests may not result in licensee’s liability.

Yes; however, if an assisted living contract refers to a resident handbook, the handbook language must also be in compliance and not waive the licensee’s liability.

No. An assisted living contract must not contain any waiver of facility liability with the health, safety and personal property of resident. While there are many situations such as natural disasters and acts of third parties which would not be the responsibility of the licensee, an assisted living licensee could be liable depending on the licensee’s role in the resident’s loss, and those narrow instances may not be waived.

No. Typical landlord-tenant contract clauses and commonly accepted landlord-tenant laws often hold the landlord is not responsible for the actions of their tenants. This ignores that assisted living facilities have heightened responsibilities with respect to their resident-tenants, who are vulnerable adults. While there are many situations, such as natural disasters and acts of third parties which would not be the responsibility of the facility, an assisted living licensee could be liable depending on the licensee’s role in the resident’s loss, and those narrow instances may not be waived.

An assisted living facility must give a complete copy of the signed assisted living contract to the resident promptly after it is signed. This signed copy must include any addendums, all supporting documents, and attachments. The resident must agree in writing to any additions or amendments to the contract.

If a resident is receiving services, their assisted living contract must include their assisted living service plan. This plan must include parts listed in Minnesota Statutes 144G.50, subdivision 4.

Yes. An assisted living facility must provide a Uniform Disclosure of Assisted Living Services and Amenities (UDALSA) to all prospective residents under Minnesota Statutes 144G.40 before an assisted living contract is signed. The UDALSA must be provided separately from all other documents and forms. Whenever a facility changes the services it offers under the assisted living contract, the facility must submit an updated UDALSA to the Minnesota Department of Health within 30 calendar days of the change in services.

No. Assisted living contracts executed prior to August 1, 2022, will not require contract amendment. Instead, MDH surveyors will review contracts executed on August 1, 2022, and after to apply the new statutory language.

Background studies

For facility staff

As of August 1, 2022, any individual holding a valid license from a health-related licensing board (HLB) who has also undergone a background check under Minnesota Statutes 214.075, shall not have a background study completed by the commissioner of human services (a NETStudy 2.0 background study). Individuals who are not currently licensed by an HLB and do not meet the conditions under Minnesota Statutes 214.057 are still required to complete a NETStudy 2.0 background study in order to be employed at an assisted living facility.

MDH has created a document to address questions from providers and organizations about these changes, which you can find here: Background Studies for HLB-Licensed Providers FAQ (PDF)

For owners, controlling individuals, and managerial officials

Each application must include documentation of compliance with the background study requirements in section 144G.13 for the owner, controlling individuals, and managerial officials.

Prior to a license being issued, a managerial official providing direct contact or a natural person who is an owner with direct ownership interest is required to undergo a background study under section 144.057.

A license will not be issued if any controlling individual, including a managerial official, has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C.

No person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C.

Definitions:

144G.08 Subd. 48. Owner: means an individual or legal entity that has a direct or indirect ownership interest of five percent or more in a licensee. For purposes of this chapter, "owner of a nonprofit corporation" means the president and treasurer of the board of directors or, for an entity owned by an employee stock ownership plan, means the president and treasurer of the entity. A government entity that is issued a license under this chapter shall be designated the owner.

144G.08 Subd. 23. Direct ownership interest: means an individual or legal entity with the possession of at least five percent equity in capital, stock, or profits of the licensee, or who is a member of a limited liability company of the licensee.

245A.02 Subd. 5a. Controlling individual: means an owner of a program or service provider licensed under this chapter and the following individuals, if applicable:

144G.08 Subd. 15. Controlling individual: means an owner and the following individuals and entities, if applicable:

144G.08 Subd. 36. Managerial official: means an individual who has the decision-making authority related to the operation of the facility and the responsibility for the ongoing management or direction of the policies, services, or employees of the facility. Per 144G.13, for purposes of background studies, this only pertains to individuals who provide direct contact.

245C.02 Subd. 11. & 144G.08 Subd. 22 Direct contact: means providing face-to-face care, training, supervision, counseling, consultation, or medication assistance to persons served by the program.

New background studies are not necessary for those that have a current eligible study affiliated with the license being renewed. New background studies will need to be completed for any recently added owners or managerial officials with direct contact.

If you have an existing background study for someone at one facility, you can affiliate the person’s background study to another facility if the Sensitive Information Person (SIP) is the same.

Affiliation is the process of adding a subject with a completed study onto another HFID’s roster without submitting a new study. For instructions on how to add an affiliation record when permissible, refer to the Help section in NETStudy 2.0: NETStudy 2.0 User Manual, page 79 or training video Roster part 2.

When a license is closed, the record is removed from NETStudy 2.0, and the roster is made inactive. Affiliation records to add background study subjects to an active roster must be completed prior to the license closing.

DHS Background Studies are not able to re-open your license once it has been closed. If you have individuals that require a DHS background study and they are not on an active NETStudy 2.0 roster, you must submit new background studies.

Pursuant to Minnesota Statutes § 144G.13, Subd 1 (a), only managerial officials who provide direct contact as defined by Minnesota Statutes § 144G.08, Subd. 22, and owners, are subject to the background study requirements. Notwithstanding the individual background study requirements during the license application process, no person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C.

Note that this response is specific to the background study requirements noted in Minnesota Statutes § 144G.13 concerning ownership, managerial officials, and controlling individuals. Applicants are subject to all other background study requirements noted in statute, including those noted in Minnesota Statutes Chapter 245C.

Per the definition of "Owner" noted in Minnesota Statutes § 144G.08, Subd. 48, "owner of a nonprofit corporation" means the president and treasurer of the board of directors. For the purpose of filling in ownership information for a nonprofit corporation on a Renewal or Provisional Assisted Living Facility License Application, applicants should list the nonprofit corporation as holding 100% of the ownership interest. The President of the Board of Directors and the Treasurer should be listed as owners with 0% ownership interest. The President and Treasurer will be subject to background study requirements.

Although not considered owners, other members of the board of directors may be controlling individuals under Minnesota Statutes § 144G.08, Subd. 15; however, pursuant to Minnesota Statutes § 144G.13, Subd 1 (a), only managerial officials who provide direct contact as defined by Minnesota Statutes § 144G.08, Subd. 22, and owners, are subject to the background study requirements. Notwithstanding the individual background study requirements, no person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C.

Please note that this response is specific to the background study requirements noted in Minnesota Statutes § 144G.13 concerning ownership, managerial officials, and controlling individuals. Applicants are subject to all other background study requirements noted in statute, including those noted in Minnesota Statutes Chapter 245C.

Once MDH has received your license fee payment, DHS/NETStudy is notified with the applicant’s information. DHS then provides the authorized agent all relevant information via the onboarding email.

The Authorized Agent will log into NETStudy 2.0. Under Applications, click on Application Forms and find the document for SIP changes (Request to Change Background Studies Sensitive Information Person (SIP)). Complete the form and submit it electronically.

The Authorized Agent will click on this link: Request to Change Background Study SIP .

Bedrails

Assisted living and home care providers must ensure residents or clients choosing to use portable bed rails are assessed for appropriateness and safety.

Per the FDA: "Bed rails are used by many people to help create a supportive and assistive sleeping environment in homes, assisted living facilities and residential care facilities. This type of equipment has many commonly used names, including side rails, bed side rails, half rails, safety rails, bed handles, assist bars, or grab bars, hospital bed rails, and adult portable bed rails."

References for accepted health standards:

Consumer bed rails

Unlike hospital beds, there is no current published guidance related to portable bed rails used on non-hospital style beds ("consumer beds"), so licensees should refer to individual manufacturer's guidelines for appropriate installation, maintenance and use. In addition, licensees should refer to the Consumer Product Safety Commission (CSPC) for the most up-to-date information related to portable bed side rail recall information.

To ensure an individual is an appropriate candidate for a bed rail, the licensee must assess the individual's cognitive and physical status as they pertain to the bed rail to determine the intended purpose for the bed rail and whether that person is at high risk for entrapment or falls. This may include assessment of the individual's incontinence needs, pain, uncontrolled body movement or ability to transfer in and out of bed without assistance. The licensee must also consider whether the bed rail has the effect of being an improper restraint.

Additionally, the licensee must ensure the bed rail is securely attached to the bed frame per manufacturer guidelines. This includes consideration of any identified contradictions of use such as height/weight restrictions, age, mattress, bed frame set up, etc.

Per the Uniform Assessment Tool, the need for assistive devices, such as bed rails, must be assessed upon initial installation, with each 90-day assessment and change of condition. (Please refer to Rule 4659.0150 where it directs assessment of mobility, including ambulation, transfers, and assistive devices.) Bed rail assessment should also be conducted whenever the type of bed rail is changed or if the rails is observed to not maintain a consistent secure attachment to the bed frame.

Even when bed rails are used according to manufacturer's guidelines, they can present a hazard. The licensee must ensure the resident and/or resident's responsible party has been educated on the risk for injury up to and including death due to entrapment.

The licensee is responsible for the safety and appropriateness of all portable bed rails in the licensee's facility for residents/clients receiving assisted living/home care services. Licensees should have a process in place for monitoring and unlicensed personnel reporting new bed rails for nurse assessment. This is also true for hospital beds delivered to the licensee's facility (for example, upon a resident's admission to a hospice service).

If a problem is found, both the assisted living facility and the home care or hospice agency can be held responsible if proper protocols are not followed.

The licensee should offer alternatives, discuss and offer interventions to mitigate safety risks, and ensure the portable bed rail is installed and secured per manufacturer's guidelines. If the licensee elects to utilize a negotiated and/or mitigated risk agreement, the licensee must maintain documentation of the offer of alternative, interventions to mitigate safety risks and conduct ongoing reassessment for the appropriate use of a bed rail.

If a licensee is unable to locate manufacturer's guidelines, they are unable to assess and determine if the portable bed rail is being used appropriately and installed properly. This results in an imminent safety risk for the resident/client.

The United States Consumer Product Safety Commission (CSPC) works to save lives and ensure safety by reducing the unreasonable risk of injuries and deaths associated with consumer products, such as portable bed rails. The CSPC posts information on its website related to portable bed rail recalls. Licensees should review the CSPC website regularly for updates on recalled portable bed rails. The opportune time to do this would be with the 90-day assessment due to the requirement included in the uniform assessment tool for assessing assistive devices.

One such element/performance/skill a prudent nurse performs is the documentation of all assessed data. If any aspect of patient care is not documented, it is viewed as not having been completed. Based on the above-mentioned statutes, the nurse must also abide by accepted health care standards, and the use of portable bed rails according to manufacturer's guidelines is one of those accepted standards. Documentation about a resident's bed rails includes, but is not limited to:

Hospital-style bed rails

To ensure an individual is an appropriate candidate for a bed rail, the licensee must assess the individual's cognitive and physical status as they pertain to the bed rail to determine the intended purpose for the bed rail and whether that person is at high risk for entrapment or falls. This may include assessment of the individual's incontinence needs, pain, uncontrolled body movement or ability to transfer in and out of bed without assistance. The licensee must also consider whether the bed rail has the effect of being an improper restraint.

Additionally, the licensee must ensure the bed rail measurements are documented and that the bed rail has not shifted and is securely attached to the bed frame per manufacturer recommendations.

Per FDA recommendations, the need for bed rails must be assessed on a "frequent, regular basis." At a minimum this would include assessment of the bed rail upon initial installation, with each 90-day assessment, or with a change of condition. (Please refer to Rule 4659.0150 where it directs assessment of mobility, including ambulation, transfers, and assistive devices to be completed as part of the uniform assessment.)

Even when bed rails meet the FDA guidelines and are used appropriately, they can present a hazard. The licensee must ensure the resident and/or resident's responsible party has been educated on the risk for injury up to and including death due to entrapment.

Per the FDA guidelines, "High-risk people include those with pre-existing conditions such as confusion, restlessness, lack of muscle control, or a combination of these factors. Additionally, people who are cognitively impaired from the use of medication or from a medical condition, such as Alzheimer's or dementia, are at a higher risk of entrapment and injury."

The licensee is responsible for the safety and appropriateness of all portable bed rails in the licensee's facility for residents/clients receiving assisted living/home care services. Licensees should have a process in place for monitoring and unlicensed personnel reporting new bed rails for nurse assessment. This is also true for hospital beds delivered to the licensee's facility (for example, upon a resident's admission to a hospice service).

If a problem is found, both the assisted living facility and the home care or hospice agency can be held responsible if proper protocols are not followed.

Per the FDA recommendations, "evaluating the dimensional limits of the gaps in hospital beds is one component of an overall assessment and mitigation strategy to reduce entrapment," and "regardless of mattress width, length, and/or depth, the bed frame, bed side rail, and mattress should leave no gap wide enough to entrap a patient's head or body." The licensee should offer alternatives, discuss and offer interventions to mitigate safety risks, and ensure the bed rail is installed and secured per manufacturer's recommendations. If the licensee elects to utilize a negotiated and/or mitigated risk agreement, the licensee must maintain documentation of the offer of alternative interventions to mitigate safety risks and conduct ongoing reassessment for the appropriate use of a bed rail.

One such element/performance/skill a prudent nurse performs is the documentation of all assessed data. If any aspect of patient care is not documented, it is viewed as not having been completed. Based on the above-mentioned statutes, the nurse must also abide by accepted health care standards, and the FDA requirements related to the safety of bedrails is one of those accepted standards. Best practice for documentation about a resident's bed rails includes, but is not limited to:

Campus definition

The definition for a campus is contained in the 7th Special Session language under 144G.08 Subd. 4a: "Assisted living facility campus" or "campus" means:

  1. a single building having two or more addresses, located on the same property with a single property identification number;
  2. two or more buildings, each with a separate address, located on the same property with a single property identification number; or
  3. two or more buildings at different addresses, located on properties with different property identification numbers, that share a portion of a legal property boundary.

No. You can hold an assisted living license in one building and an assisted living with dementia care for another one.

Yes, unless you meet the campus definition as above.

No. Per definition you will be required to license each of these entities separately.

Cannabis use

This guidance was created as a collaborative effort with the Office of the Ombudsman for Long-Term Care, Minnesota’s Long Term Care Imperative, and staff from the Minnesota Department of Health to respond to questions regarding recreational adult-use cannabis submitted by long-term care providers. It is not intended to be used by the general public.

This guidance is not intended to provide guidance for medical marijuana use, and may not address all provider questions. Facilities are encouraged to work with their legal teams to ensure compliance with all state and federal requirements.

Minnesota Statutes, section 152.261 remains an active requirement on health care professionals to report medical cannabis overdoses. This repeals in 2025.

Providers that accept Medicare and Medicaid funding are required to comply with certain federal standards and laws. Cannabis remains a Schedule I drug under the Controlled Substances Act and providers should establish policies in accordance with applicable federal, state, and local laws and regulations.

As a nursing facility or assisted living facility, can we prohibit personal use of cannabis by residents of the facility who are age 21 years or older?

Minnesota Statutes, section 342.09, subdivision 1(a)(7)(ii), permits the owner of a private property to prohibit the consumption of cannabis flower, cannabis products, lower-potency hemp edibles, or hemp-derived consumer products by individuals on that property. This includes medical cannabis flower and medical cannabinoid products. The law does not address how this impacts nursing homes and assisted living facilities, specifically.

Effective March 1, 2025, Minnesota health care facilities are not generally permitted to prohibit the use of medical cannabis or medical cannabinoid products by patients enrolled in the medical cannabis program, although they are allowed to institute reasonable restrictions on the use of those products by residents in the facility (Minnesota Statutes, section 342.56). Should a facility change its policy from one that permits adult-use cannabis to one that does not, the facility should work with their interdisciplinary team, Office of Ombudsman, and residents to ensure protocols reflect Quality of Life for the residents the facility serves. Facilities should communicate their policies prior to a resident’s admission.

Can I limit the types of adult-use cannabis products in my nursing home or assisted living facility?

Yes. For example, a facility could prohibit the use of smokable adult-use cannabis (either flower/bud or vaped), the use of cannabis products, or both. Facilities should have clear protocols in place per their policies and procedures.

Is my facility required to provide secured storage of a resident’s adult-use cannabis in their room?

Beginning March 2025, Minnesota Statutes, section 342.56 subdivision 2, does not require health care facilities to store, maintain, or provide adult-use cannabis for patients. However, requiring secured storage could protect other cognitively impaired residents, your staff, and others from misuse and/or allegations of missing cannabis product. Your facility policy should require that cannabis products be secured at all times.

If my facility is aware that a resident is consuming adult-use cannabis products, is the facility required to share that information with the resident’s primary health care provider?

A resident/resident representative should sign an acknowledgement of the facility’s medical cannabis/adult-use cannabis policies and that those policies include language that the resident/resident’s representative understands the facility may communicate with the resident’s treating physician/PA/NP if the facility believes that to be in the best interests of the resident.

Is a facility required to include adult-use cannabis consumption on a resident’s medical record?

Facilities should comply with State and Federal requirements for medical record keeping.

Who is responsible for disposing of a resident’s cannabis?

The resident or the resident’s designee is responsible for cannabis disposal. Residents should not give cannabis to facility employees for disposal. Disposal of a resident’s adult-use cannabis due to death or discharge should be addressed in facility policy, similar to other resident possessions.

Can a resident store adult-use cannabis in their room?

Facilities could include a reasonable restriction on the maximum amount stored in their policies. Just as they might limit the amount of alcohol stored in a room. Storage limitations may differ between smaller nursing facility rooms compared to assisted living apartments.

Can a person with a motorized scooter or motorized wheelchair operate these devices while under the influence of adult-use cannabis?

Facilities should address this in their policies. In addition, facilities should ensure the resident’s assessment reflects a review of this. For example, the facility should be able to demonstrate their efforts to determine whether the use of adult-use cannabis will affect the resident’s ability to operate a mobility device safely. For further clarification, see Minnesota Statute, section 169.011.42.

Is my facility required to allow a resident to grow cannabis in their room?

A long-term care setting should develop policies and procedures related to this issue. A long-term care facility may need to apply considerations based on roommate preference, safety concerns, and space limitations as identified in facility policies. Safety concerns, such as the use of a heat lamp or storage of growth chemicals, should be taken into account when developing policies and procedures.

Per Minnesota Statute: Adults are permitted to grow up to eight (8) cannabis plants per single residence, with no more than four (4) being mature and flowering at the same time. Cannabis plants must be kept in an enclosed, locked space that is not open to public view.

Can a facility require resident disclosure of adult-use cannabis consumption?

This should be handled the same way the facility handles use of alcohol by residents.

Can a facility prohibit family members or guests from bringing in adult-use cannabis for residents?

This should be handled the same way the facility handles alcohol brought in by family members or guests for residents. All facility restrictions would still apply as outlined in the facility policies (e.g., smoking/vaping restrictions).

Can a Medicaid beneficiary use their personal needs allowance to purchase adult-use cannabis?

Yes – this is their money to spend on any legal personal purchases.

Change of Ownership (CHOW)

An assisted living facility license may not be transferred to another party. A prospective licensee must apply for a license prior to operating a currently licensed assisted living facility. The applicant is required to submit "written notice" to the department at least 60 days prior to the anticipated CHOW date. Preferably this notice would be in the form of the application and attachments.

A new license is required whenever one of the following events occur: