At last I wrote to the MN regional ombudsman for assisted living:

My person is in an assisted living memory care facility.  The administration has been careful about COVID precautions; the facility keeps residents from interacting with anyone except staff and essential caregivers.  This facility has not yet begun allowing indoor visits.  I’m an essential caregiver and I do get to visit my person, and I’m grateful for that.

The meals are adequate.  So, in general, my person is reasonably safe and has acceptable housing and nutrition.

I do have some concerns, and I wanted to talk confidentially about those concerns.  I don’t want to make a complaint.  I do want to register these concerns, because cumulatively they affect health outcomes.

1. One of my concerns is directly related to “Updated Guidance for MDH-Licensed Providers of Residential Settings with At-Risk Residents | COVID-19” dated March 16, 2020. That document called for residential facilities to “1. Cancel communal dining and all group activities, such as internal and external group activities.”

At the facility where my person lives, the result is a new form of warehousing.  The facility offers meals and tv.  That’s it.  This is troubling on two counts.  First, the tv-watching is just as likely to spread infection as an activity or a class – people aren’t required to sit six feet apart.  If MDH rules allow residents to cluster for something passive and sedentary, why can’t MDH change the rules to allow for small, distanced activities that provide some exercise and stimulation? My person went to the gym six days a week before COVID.  Now my person gets no exercise, and when I asked for advice the medical staff at the facility suggested getting weights and a pedaller.  We’re talking about asking someone in memory care to create and sustain an exercise program without supervision or assistance.

2. The handbook for the facility hasn’t been updated to include any of the COVID-related restrictions or protocols. This has led my person to read and reread the handbook and to feel frustrated and angry.  My person entered the facility in summer, over three months after the March 16 directive, but the handbook we were given is a pre-COVID version. The handbook specifically says, for example, that residents can leave the facility; it doesn’t say that during the COVID period residents who leave for anything other than a same-day doctor’s appointment will have to be quarantined in their rooms for 14 days.  That’s just one example of an inaccuracy that causes frustration and anger and contributes to my person’s sense that the facility is a prison.

The website and the documents we were given describe the person-centered programming.  Neither of us had any idea that the programming amounts to serving meals and turning on the tv.

3. There’s also a potential safety issue. The handbook specifically says that residents will be issued keys. My person was issued a key only after another resident repeatedly entered the room and took some of my person’s belongings.  My person cannot manage the button lock or the key – and hasn’t been able to lock or unlock doors with keys reliably for the past five years.  The fob/electronic lock system used elsewhere worked fine, but the administrators at this facility nixed that idea.  Wandering residents can barge in at any time, day or night, if my person can’t manage to lock the door.  The prospect of unwanted people entering the room during the night has disrupted my person’s sleep and ignited acute anxiety, and the pilfering has caused distress.

4. Less urgent, but disturbing: as my person’s POA, I need information that I simply cannot get. My person’s financial planner requested an itemized bill for the monthly cost, and I’ve been told no such thing exists.  How is that possible?  Does MDH allow AL facilities to bill a lump sum with no breakdown of costs?  That creates real difficulty for tax planning: it isn’t possible to determine the deductible medical expenses that are part of the monthly fee.  (It’s especially odd because the monthly fee, in the thousands of dollars, ends in $41.  Someone in some office somewhere must have completed a calculation that arrives at $XX41.)

Absent the licensure regulations that haven’t taken effect, I worry that there’s no incentive for the facility to improve its care or to ask residents and families to evaluate services.  Another year of eating meals and sitting in front of the tv, another year of worrying (literally, obsessing) about residents entering the room and taking possessions and being afraid to sleep at night will likely hasten my person’s decline.

I’ve raised these points with the administration and have received prompt communication – communication that I’d describe as placating without actually taking any meaningful action.  Short of contacting the Star Tribune or Minnesota Public Radio to suggest a piece focusing on the fact that MN is the only state that hasn’t licensed AL facilities and on the new warehousing of the elderly in COVID time, I’m not sure what to do next.  I’d appreciate advice.