Minnesota's top health regulator unveiled a plan Wednesday to intensify oversight of the state's rapidly growing assisted-living industry, amid growing concerns that an absence of basic care standards is putting thousands of seniors in harm's way.

At a legislative hearing Wednesday morning, state Health Commissioner Jan Malcolm proposed a system for licensing assisted-living homes, which now serve more than 60,000 Minnesotans but operate under less supervision than state-licensed nursing homes. Minnesota is the only state that does not license such facilities, making it difficult for the state to enforce minimum standards of care for an increasingly vulnerable population.

"We need to build on that system and create higher levels of regulation, including licensure, tied to the complexity of the services that are offered in those settings and the complexity of need," Malcolm said in her testimony.

The case for reform gained momentum early last year following a Star Tribune investigation detailing how such facilities had failed to protect their residents from hundreds of incidents of criminal abuse, including beatings, sexual assaults and thefts. The report also found that residents of assisted-living facilities had few protections against unsafe or unfair business practices. Those who spoke openly about being mistreated sometimes faced retaliation by facility staff, and even threats of eviction, the Star Tribune found.

In March, the Legislative Auditor issued an in-depth report highlighting that Minnesota had fallen behind other states in its regulation of assisted-living facilities. Without licensing requirements, the auditor found, the state was hamstrung in its ability to hold facilities accountable for maltreatment. Even in severe cases, such as when a person wandered away from a facility and died, the state lacked basic standards for evaluating the facility and preventing further deaths.

Assisted-living facilities, which often resemble apartment buildings with services, were intended originally for older people who needed help to live independently, such as housekeeping and cooking, but wanted greater freedom and social interaction than they would find in a conventional nursing home. Over time, however, the distinctions have blurred and assisted-living facilities have begun catering to residents who are frail or have serious medical conditions. More than 40 percent of assisted-living residents, for example, have Alzheimer's disease or other forms of dementia; and nearly two-thirds are so frail they need assistance bathing, national studies have found.

"Assisted-living is the fastest-growing residential care option for elders in the United States, and regulations have not kept up with the realities on the ground," said Eilon Caspi, a gerontologist and research associate at the University of Minnesota School of Nursing.

However, when the state convened a working group last fall to explore licensing, it immediately faced a challenge: How to create a single licensing system for a highly diverse industry. Many of Minnesota's assisted-living facilities are little more than shared-housing communities that provide some personal care services, such as cooking or cleaning. Others have opened specialized "memory care" units for people with dementia, and provide skilled medical care similar to that in nursing homes.

To reflect this complexity, the Department of Health is proposing a multitiered licensing system based on the services offered and the needs of the residents being served. Assisted-living facilities that provide complex medical care, for example, would operate under greater scrutiny than communities that offer little more than housing. State officials are also exploring the possibility of creating a separate certification system for dementia care units with minimum care standards, such as a requirement that staff be on site 24 hours a day.

Currently, state law classifies assisted-living facilities as part of a broader group of "housing with services" providers, which are registered but are not licensed by the state. Even so, assisted-living facilities now serve about 60,000 residents, more than twice as many people as nursing homes, according to state data.

Unlike a year ago, when a broad-based effort to reform Minnesota's laws for protecting seniors collapsed amid partisan discord, there appears to be strong bipartisan support in the 2019 Legislature for licensing assisted-living. The leaders of long-term care committees in both houses support the measure, as does the senior care industry's largest trade group, Care Providers of Minnesota.

Malcolm said she expects to share draft language of a bill that would establish assisted-living licensure with key legislators and stakeholders in the next couple of weeks. "My goal is to get licensure done this session," added Rep. Jennifer Schultz, DFL-Duluth, chairwoman of the House Long-Term Care Division. "The people of Minnesota who have loved ones in these facilities will feel more confident they are receiving more quality care."

Still, industry groups and consumer advocates might disagree significantly over the specifics, including the mandatory care standards that would be included in any licensing framework. A coalition of senior organizations — including AARP Minnesota, Mid-Minnesota Legal Aid and Elder Voice Family Advocates — is pressing for a host of new standards, including stronger protections against arbitrary evictions and the right to use surveillance cameras to monitor care.

"It's easy to agree on concepts," said Kristine Sundberg, president of Elder Voice Family Advocates, a volunteer group seeking better care for seniors. "The real challenge will be settling on the specific standards that would protect people who are not being protected now."

Chris Serres • 612-673-4308 Twitter: @chrisserres