The future of a large provider of housing and other services for Minnesotans with disabilities remains in doubt after the organization appealed a recent state order to revoke its license for numerous health and safety violations.

In a highly unusual move, the Minnesota Department of Human Services (DHS) last week ordered the revocation of the license of Bridges MN, which has some 500 clients and more than 90 group homes statewide, because of "serious and repeated" violations and findings of maltreatment involving vulnerable adults. The alleged violations included failure to report sexual abuse, neglect of care and leaving clients in unsanitary conditions, according to a June 27 licensing revocation order.

Now, Bridges MN is disputing the state's findings and has formally appealed the revocation order, which sets in motion a long, complicated process for determining whether the St. Paul-based provider will be allowed to continue operating over the long term.

Under state law, Bridges MN can continue to provide services to people under its care, but the appeal process could take months or up to a year to resolve, state officials said.

Meanwhile, many people with disabilities and mental illnesses who have come to rely on Bridges MN for housing, in-home care, and other services are in limbo, unsure whether to wait for a final determination or seek alternative care providers. Finding alternatives is potentially daunting at a time when care providers across Minnesota are struggling with a severe staffing shortage and long wait lists. Some social workers and families report waits of a year or longer for spots in group homes or day activity centers that support people with disabilities.

Statewide, more than 170 group homes have shut down since October, about 4% of the state's capacity, according to a recent analysis by ARRM, the state's main association for group home providers. A survey last year by the association found widespread burnout among direct caregiving staff in group homes, with 67% of these workers saying they planned to quit within a year.

"Where else can I go?" asked Kimberly Nelson, 51, who has limited mobility because of multiple sclerosis, and lives at a Bridges MN group home in Prior Lake. "It's impossible to move when no one has enough staff and all I hear is that all these [group] homes are closing and they can't make room for people like us."

The rare licensing action follows a history of regulatory problems at Bridges MN, and has raised questions among some disability advocates about whether the state's enforcement powers are adequate. The provider has operated under a conditional license for the past two years and been sanctioned more than 50 times over that period for a host of alleged infractions. Those include reports of unsanitary conditions, failure to provide basic care, failure to complete required background checks on new hires and failure to report maltreatment.

In a case early this year, a sick client who received in-home care from Bridges MN was found "lying in feces and vomit" according to the license revocation order. The person was taken away in an ambulance and died soon after. The staff who visited the client said they "sometimes" helped clean the apartment and "sometimes did not," the licensing order said. DHS found Bridges MN was responsible for neglect of the vulnerable adult, according to the licensing order.

At a Bridges MN facility in Forest Lake, state inspectors followed up on a report that a staff person had a sexual relationship with a resident. During the investigation, regulators received information that the staff person had choked the resident and had used cocaine while driving and providing services to the client, the licensing order says.

On site visits, state inspectors found that staff members appeared to be asleep on couches for hours at a time when they were supposed to be providing care, according to the licensing action.

"It's not just smoke. It's not just a couple of fires," said Barnett Rosenfield, state ombudsman for mental health and developmental disabilities, of the regulatory problems at Bridges MN. "There were a lot of problems here over a period of time in which something had to be done. But that leads to a whole bunch of associated, 'So now what?' kinds of questions."

Bridges MN strongly disputes the DHS enforcement action. In a written statement, the provider said the allegations of failure to report and maltreatment determinations are "wrong and exaggerated" and contain factual mistakes. The provider filed a 17-page appeal on July 1, though the contents of the document remain confidential and unavailable to the public. Bridges MN declined to share the appeal, saying it contained private patient information. DHS also declined to provide a copy of the appeal document, asserting that it is private data under state law.

Had Bridges MN not filed the appeal, the provider would have been prohibited from providing services as of 6 p.m. on July 12, according to the order. The matter now goes before a state administrative law judge, who will issue a recommendation to the Human Services Commissioner on whether to uphold or affirm the license revocation.

"As in everything we do, we are motivated and inspired by the more than 500 individuals we serve; we do not want their care to be interrupted," Bridges MN said. "Left to take effect, the department's order would put the health and safety of hundreds at risk and do so based on unsound and unfounded legal theories and incomplete and inaccurate information."

For now, however, hundreds of Bridges MN clients face difficult choices about how and whether to prepare for the possibility that the provider may lose its license.

Nelson said she has been exploring other living options, including the possibility of moving to her own apartment. The search is complicated by her limited funds. Nelson's primary source of income is $1,200 in monthly Social Security disability payments — not enough to cover the cost of rent and living expenses in most Twin Cities apartment buildings. And if she moved out of her group home, Nelson said she would have to hire her own team of caregivers — a daunting challenge amid a workforce crisis.

"I feel stuck," she said. "My hope is that the state lawmakers wake up and recognize that people need help — and not wait to act until there's a crisis."