State of Minnesota Long-Term Care in 2025

State of MN LTC in 2025 Final - Investigation Report .pdf

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In Minnesota, if an elderly person dies as a result of neglect or abuse in a long-term care facility, the maximum fine is just $5,000. Meanwhile, animal cruelty can result in up to two years in prison, a $5,000–$10,000 fine, and restitution for the cost of care.

This indifference to the suffering—and needless deaths—of older adults is commonplace in far too many long-term care facilities, as this research demonstrates.

Elder Voice Advocates (EVA) and others successfully worked to pass legislation to license assisted living facilities, believing it would finally lead to improved care. That law took effect on August 1, 2021—and yet, the trajectory has not improved and seems to be moving in the opposite direction.

Transparency drives accountability and reform. EVA prioritizes transparency because we have learned that secrecy protects poor performers, not residents. When the public can see the true scope and patterns of abuse, neglect, and exploitation, providers face greater pressure to improve care, policymakers are more likely to act, and families can make informed decisions. Visibility drives accountability, and accountability drives change.

EVA will continue its mission to use research and insights to make transparent the actual state of elder care in Minnesota.

EVA Uncovers Alarming Patterns of Substandard Care by For-Profit Providers

EVA has identified troubling patterns of poor care by for-profit long-term care providers throughout Minnesota. These profit-driven operators dominate the senior care landscape and are linked to needless suffering and death.

The 2025 Minnesota Department of Health (MDH) substantiated investigations of abuse, neglect and exploitation were reviewed with a focus on underlying causes, history of maltreatment and staff issues.

EVA’s research is distinct in scope and methodology. While maltreatment has been studied through isolated incident reports, surveys, or administrative datasets, this research has systematically integrated regulatory findings, investigative records, and historical patterns of maltreatment to reveal the full scope of harm across care settings.

Key Findings from MDH Substantiated Investigations of Abuse, Neglect and Exploitation:

• 79% occurred in for-profit assisted living, assisted living/memory care, nursing homes, home care, boarding care and hospice.

• 72% occurred in assisted living and assisted living with memory care.

• 23 deaths in 2025 are directly attributed to neglect and/or abuse

  • 21 deaths were by for-profit providers – 91%

  • No recorded fines were issued for any of these deaths

  • 19 providers had a history of prior substantiated investigations

Drivers of Substandard Care

For-profit failures.

The growing influx of for-profit operators has significantly degraded the quality of care. These providers operate on a business model, not a quality-of-care model. Their cost-cutting leads to substandard care, while owners maintain generous profits. Revenue transparency is lacking, and revenues are clearly not being reinvested into improving care.

Severe lack of accountability.

A $5,000 fine is merely a cost of doing business, not a meaningful deterrent. The most egregious facilities are investigated but remain open, even when some have long histories of dozens of substantiated investigations and failed surveys.

Underfunded oversight and enforcement.

With its current funding, the Minnesota Department of Health is able to investigate only approximately 15% of the complaints it receives. These findings, therefore, represent the tip of the iceberg and reflect systemic state public policy indifference toward the elder rights to quality care. Laws are only as effective as their enforcement.

Improve Transparency to Drive Reform of Elder Care

Minnesota’s older adults and people with disabilities have a fundamental human right to safe, quality care. Yet repeated findings of systemic breakdowns in oversight and enforcement show that the current public policy framework is not strong enough to protect them. Residents’ needs must come before provider profitability. To change outcomes, Minnesota must adopt stronger public policy protections, meaningful transparency, and real accountability. Without them, the promise of quality care remains out of reach.

We must:

• Strengthen and fund effective and transparent regulatory oversight of all providers

• Increase and enforce meaningful fines for harmful care

• Pass laws that raise standards of care

• Allow consumers legal recourse when providers commit wrongdoing

Require for-profit operators to report detailed financial and operational data

True reform requires a coordinated approach: stronger oversight, meaningful transparency, and penalties significant enough to change behavior. Together, these tools create the accountability necessary to protect people receiving care and motivates providers to improve care.

Kristine Sundberg,

Executive Director

Elder Voice Advocates – Elder Care IQ