1. Name of Establishment
2. Address, City, State, Zip
3. Phone
4. Fax
5. Website
6. Contact Person

The format for this Guide was developed to help you compare housing, services and costs. This Guide is designed to help you choose a Housing with Services Establishment, but you will need more information before you make a final decision. Be sure to visit the places you are considering, and ask to meet with a staff person one-on-one to discuss your specific needs and preferences.

The legal requirements for Assisted Living vary by state. In Minnesota, providers may call themselves “Assisted Living” only when they meet basic requirements under Minnesota law [MN Statute 144G]. Minnesota’s laws related to Assisted Living are based on the concept of “housing with services.” In this setting, you are renting “housing” and buying assisted living “services.” A single company may provide both the housing and the services, or the building may have an arrangement with home care agencies and other companies to provide some or all of the services. The rights you have as a tenant of the housing and a client of the services are listed on the last page of this Guide.

While Establishments vary in size, services and costs, they share a common philosophy: that each individual makes informed choices about where they live and what kind of help they need; and that each individual lives with their maximum independence, dignity, respect and privacy.

This Guide is designed to help you find the Establishment that best matches your needs, but no Guide can cover every detail. You can get further information, at no cost, about care options from:

• Senior LinkAge Line at 1-800-333-2433; www.mnaging.org/advisor/SLL.htm
• County’s Long Term Care Consultation Telephone number: 1-800-657-3591
• Office of Health Facility Complaints for concerns related to Home Care Provider at 651-201-4201 or e-mail at ohfc-complaints@health.state.mn.us
• Office of Ombudsman for Long Term Care at 1-800-657-3591; www.mnaging.org
• Minnesota Directory to locate community resources: www.MinnesotaHelp.Info

When you move into a building, you will sign a rental or residency agreement that covers your occupancy of an apartment or unit. Review this agreement carefully prior to signing because it will identify situations when the landlord could ask you to move out, such as non-payment, damage to the building, or other reasons.

In addition to a rental agreement, you will also sign a service agreement or service plan that covers services you will receive from the licensed home care provider. The building owner may be the home care provider and other times services may be provided by one or more outside home care providers. You have the right to choose freely among home care providers and to change providers after services have begun. This building has an arrangement with the following home care agency to provide services to its tenants.

Home Care Provider
1. Name of home care provider
2. Address, City, State, Zip
3. Phone
4. Fax
5. Website
6. Contact Person
7. MN Department of Health home care license Comprehensive home care license Basic home care license Class F home care license Class A home care license 8. Medicare Certified Yes No

Notes regarding MDH home care licenses.

• A Comprehensive home care provider can provide home care services any place the client lives and may provide therapies including, but not limited to, physical and occupational therapy.
• A Basic home care provider can provide home care services any place the client lives and cannot provide therapies such as physical or occupational therapy.
• A Class F home care provider can only provide home care services in a housing with services setting and cannot provide therapies such as physical or occupational therapy.
• A Class A home care provider can provide home care services any place the client lives and may provide therapies including, but not limited to, physical and occupational therapy.
• Only a Medicare Certified home health agency (Class A or Comprehensive license) is eligible to receive Medicare payment.

The following table includes information about the minimum amount it will cost you to live here, depending on the type of unit you choose. In addition to rent, the monthly base rate may include some services (see pages 5 and 6). Be sure to ask if there are other required fees or charges besides the base rate, such as security deposit, garage fee, charge for a registered nurse assessment or other fees.

Two-bedroom apartment

Square Footage (include range)

Check if Private Bath

Monthly Base Rate (include cost range)($)

One-bedroom apartment

Square Footage (include range)

Check if Private Bath

Monthly Base Rate (include cost range)($)

Studio/efficiency apartment

Square Footage (include range)

Check if Private Bath

Monthly Base Rate (include cost range)($)

Private room

Square Footage (include range)

Check if Private Bath

Monthly Base Rate (include cost range)($)

Semi-private room

Square Footage (include range)

Check if Private Bath

Monthly Base Rate (include cost range)($)

Other

Square Footage (include range)

Check if Private Bath

Monthly Base Rate (include cost range)($)

Note: Monthly base rate may include some supportive and/or health-related services.

Monthly Base Rate includes the utilities checked below

Heat

Electricity

Telephone

Cable or Satellite TV

This building has the following security features and systems for controlling who enters and exits the building

Security guard

Key card access

Other lock system

Additional accessibility features: See attached description

This building has the following accessibility features

Elevator

Ramps

Accessible bathrooms

Additional accessibility features: See attached description

Is smoking permitted in tenants’ rooms/apartments?

Yes

No

Additional deposit required

Are pets permitted?

Yes

No

Additional deposit required

Types or sizes of pets are limited: See attached description.

Staff Availability for Establishments using the phrase Assisted Living

Minnesota law requires establishments to have someone available 24 hours per day, 7 days per week, who is responsible for responding to client requests for assistance with health or safety needs:

Is the responsible person(s) in this building awake at all times?

Yes

No

This building’s system is

Payment for Rents and Services

Rent: This building has or accepts the following forms of payment for rent:

The building offers reduced rents for income-qualified persons or accepts federal rent subsidy

The building accepts Minnesota Group Residential Housing payments for rent and included food costs for qualified, low-income persons

Private pay / Co-pay

Long Term Care Insurance

Services: This building’s home care provider is eligible to receive and accepts the following types of payment for health-related services:

Medicare reimbursement for Medicare-eligible services (See http://www.cms.gov/center/PeopleWithMedicareCenter.asp for general Medicare information)

Medical Assistance (Medicaid) reimbursement for eligible services for qualified low-income persons (such as Elderly Waiver or CADI)

Private pay / Co-pay

Long Term Care Insurance

General note about public assistance: Be sure to ask about any limits that may apply if the provider accepts public funding for rents or services. If you need assistance in paying for your housing or your services, contact the county to determine if you are eligible for Medical Assistance or Group Residential Housing. For information on subsidized housing, contact Senior LinkAge Line at 1-800-333-2433.

Supportive Services

Note: Assisted Living Establishments must offer at least: (1) two meals per day, (2) weekly housekeeping and weekly laundry service, (3) a system for daily checks, and (4) “awake” staff 24/7 to respond to health and safety needs of clients.

The following special diets are available:

Diabetic

Low sodium

Other

Personal Care (Activities of Daily Living) Assistance

Note: Check with provider for how they define times for days, evenings and nights.

Minnesota law requires establishments using the phrase Assisted Living to make available an RN assessment at the time of or prior to move in. Contact to make arrangement for this assessment.

Health Care Related Services – Class A or F ONLY

Note: Check with provider for how they define times for days, evenings and nights.

See attached special notes for health-related services.

Minnesota law requires establishments using the phrase Assisted Living to make available an RN assessment at the time of or prior to move in. Contact to make arrangement for this assessment.

Health Care Related Services – Comprehensive and Basic ONLY

Note: Check with provider for how they define times for days, evenings and nights.

See attached special notes for health-related services.

Your Legal Rights