Audit: Minnesota needs to improve assisted living oversight, inspections
Minnesota was the last state to license assisted living. A report sees more work needed to improve oversight.
The Minnesota Star Tribune
SEPTEMBER 9, 2026 AT 2:49PM
Laura DeGree watches the Olympics with her father, Richard Thomalla, as she visits him at Polar Ridge Senior Living in North St. Paul on Feb. 19. Thomalla lives in an assisted living memory care unit at the living center, which DeGree says she pays more than $12,000 a month for but her father is often neglected.
Minnesota has fragmented oversight of the growing assisted living industry and inspections of the facilities often are done months later than they should be, a new report found.
Meanwhile, a state report card intended to help older adults and people with disabilities choose an assisted living facility leaves out key information about maltreatment cases, according to an Office of the Legislative Auditor evaluation published Wednesday.
Minnesota was the last state to license assisted living facilities, doing so in 2021. Lawmakers asked the legislative auditor last year to look into how licensing is going and whether it has improved residents’ experiences.
The report recommended numerous oversight and transparency changes. It comes amid renewed concerns about quality of care and potential fraud by facility operators.
Lawmakers need to take steps next year to protect people in assisted living, said Sen. Ann Rest, DFL-New Hope, who has had issues with assisted living ownership in her community.
“It’s our role as legislators to make sure [residents’] rights and privileges are respected,” she said.
The backstory: The state started licensing assisted living because the rate of abuse and maltreatment was “very, very alarming,” said Sen. Scott Dibble, DFL-Minneapolis.
The legislative auditor’s office, which raised red flags in 2018 about protection of vulnerable adults, focused on licensing in the latest report and didn’t do a full-blown ”where are we now?’” assessment, said David Kirchner, who led the evaluation.
However, advocates and families of those who have been neglected or abused in assisted living facilities have continued to sound the alarm about poor care at some properties.
And a recent criminal case and media reports have added to concerns about oversight.
A woman allegedly tied to a prostitution ring owned an assisted living company, and one of her homes was previously used as a commercial sex house. In another situation, illuminated by MPR News and APM Reports, a Liberian government official was supposed to be overseeing several homes.
By the numbers: Minnesota has 2,533 licensed assisted living facilities, 545 of them having opened since August 2021, according to the Health Department. The rest were previously operating and registered with the state but didn’t need a license.
While people often think of assisted living as apartment-style communities where older adults can receive some help, state data shows roughly half of the licensed facilities in the state serve five or fewer residents.
Residents at the smaller providers tend to be in their late 50s and 60s and may be experiencing significant mental health or substance use challenges, said Rajean Moone, who leads the University of Minnesota’s Long Term Care Administration Program.
About 97% of the small facilities are in the metro area, Kirchner said. He said the care for most of the residents at the smaller facilities is paid by Medicaid.
How it works: A couple state agencies are involved in overseeing assisted living.
The Minnesota Department of Health licenses, inspects and investigates complaints about assisted living sites. That department has ”really struggled" to conduct inspections on schedule, Kirchner said. While the agency has gotten better over the years, he said during the first half of last year more than a third of inspections were at least 90 days late.
Meanwhile, the Department of Human Services oversees the Medicaid-funded care someone gets at an assisted living facility.
There is not always clear information shared between agencies, Kirchner said, and health inspectors should be helping check that people in the facilities they visit are getting Medicaid-funded services.
“That’s an opportunity for the state to do a better job of oversight and make sure the money is it paying is leading to the services it wants to pay for,” he said.
The two departments are working “more closely than ever” to find problems and bad actors and quickly address them, Health Department Deputy Commissioner Wendy Underwood said.
“Reports of facilities where people are not getting the care they need, or unsafe living conditions, or signs of fraud are unacceptable. When we see this, we act,” she said.
The Department of Human Services is responsible for the assisted living report card launched in 2024, which gives facilities ratings between one and five stars.
The department lacks some “fairly basic information” to inform those ratings, said Kirchner, such as the number of residents and staff at a facility. The star ratings also fail to factor in serious maltreatment findings or licensing sanctions.
One facility had multiple substantiated maltreatment allegations that led to several hospitalizations and a death, Kirchner said, and that wasn’t incorporated into the star rating.
“We feel like it is misleading, honestly,” he said.
The report card was the first of its kind in the nation and there is room for improvement, Department of Human Services Commissioner John Connolly said. The star ratings draw from state surveys and it is “doable” to also weave in maltreatment reports, he said, but would “take time and development and resources.”
The conversation: Lawmakers and state agency officials said at a meeting Wednesday that they want to act on some of the report recommendations.
The Health Department plans to propose changes next year to address regulatory gaps, said Carol Backstrom, assistant commissioner for the agency’s Health Systems Bureau. She noted a state workgroup is starting this fall to look at licensing requirements for small assisted living facilities.
“There are a lot of holes here and lots of trust [of assisted living providers] that goes on,” said Rest. She said legislators have left significant gray areas in the laws regulating state agencies’ responsibilities and authority, which need to be clarified.
The legislative auditor’s findings “should be a call to action for the next Legislature and administration to step back and examine the regulatory framework as a whole,” Kari Thurlow, who leads the group LeadingAge Minnesota, said in a statement. Her organization lobbies for assisted living and other care providers.
“Older adults and their families need a system that gives them meaningful information, preserves choice, supports access to affordable care, protects their safety and holds bad actors accountable,” Thurlow said.
Kristine Sundberg leads the group Elder Voice Advocates that has been raising concerns about maltreatment and pressed for the auditor’s office review. She said the next governor must “take a leadership role in revamping the oversight of long-term care.”
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