Assisted livings were meant to be a home, not a nursing home
By Toby Pearson | May 7, 2026 | All members
Minnesota needs an honest conversation about assisted living.
Across the country and here in Minnesota, assisted living communities are increasingly being treated, regulated and publicly judged as though they are skilled nursing facilities. But assisted living was not created to be a nursing home, or a mini hospital. It was created as a home-like, social model of support. A place where older adults could live with dignity, privacy, independence and help with daily needs.
That distinction matters.
Assisted livings were originally designed for people who were mostly independent but needed assistance with services such as meals, housekeeping, medication management, bathing, dressing or other day-to-day supports. It was intentionally different from skilled nursing care, which provides 24/7 medical care, licensed nursing coverage and institutional-level clinical oversight. As one national article noted, assisted living facilities “were originally more like retirement villages than nursing homes,” helping active older adults maintain independence in a home-like setting with ancillary services. They “did not offer the intensive, long-term care provided by skilled nursing homes.”
But the reality has changed. Minnesotans are living longer, often with more complex chronic conditions, dementia and mobility challenges. Nursing home beds are shrinking. Families overwhelmingly want to avoid nursing home placement when possible. And assisted living has become the setting many families choose, not always because they are clinically the best fit, but because it feels more like home.
That is understandable. National polling cited in the Star Tribune found that 90% of Americans say they do not want to live in a nursing home. In Minnesota, assisted living apartments far outnumber nursing home beds. In Minnesota we have embraced assisted living with our elderly waiver program paying for services in assisted living as an alternative to nursing homes. However, the lines between home and community-based assisted living and institutional nursing home care are becoming increasingly blurred.
Public policy is not keeping up in a thoughtful way.
Instead, assisted living providers are being asked to operate under a growing regulatory framework that increasingly resembles skilled nursing. Minnesota law requires assisted living to be licensed, and with that there is a plethora of regulations such as: staff to be training and competencies, registered nurses available for consultation when staff are performing delegated nursing tasks. Many of these requirements lead to higher quality and better outcomes for residents. However, Elderly Waiver in assisted living does not pay for the rent to stay in the apartments, does not have the same reimbursement system payer structure or 24/7 licensed nursing model as nursing homes. That is not a loophole. It is the model.
The question should not be whether residents deserve safety, accountability and quality care. They absolutely do. The question is whether Minnesota can keep layering nursing-home-style expectations onto assisted living without acknowledging what assisted living is, what it is not, and what it would cost residents to turn every assisted living setting into a quasi-skilled nursing facility.
There are real risks when expectations and reality diverge. Families may assume assisted livings can provide the same level of care as a nursing home. Residents may understate their needs because they want to remain in a more home-like setting. Providers may be blamed for not being something they were never designed or funded to be.
Minnesota needs better clarity, not more confusion and regulation.
Research on long-term care has warned for years that the country has created a false divide between the “social model” and the “medical model.” Assisted livings are rooted in a social model and although the settings share values such as dignity, privacy, choice, independence, the two models diverge in emphasis of a home-like setting and the ability to age in place. But medical needs do not disappear simply because someone lives in a residential setting. At the same time, “medicalizing or institutionalizing” every residential setting undermines the very qualities that make assisted living valuable. That is the balance Minnesota must get right.
We should not respond to every concern in assisted livings by imposing one-size-fits-all regulations and staffing mandates that do not reflect resident acuity, facility size, geography, workforce availability or payment realities. These regulations and mandates sound simple until policymakers confront the fact that the workers do not exist in sufficient numbers, the funding is not there to pay for them, and not all assisted livings can provide all of the cares a resident may need. A mandate without a workforce plan is not a solution. It is a mandated promise providers cannot keep and families cannot rely on.
Minnesota should instead pursue a more honest framework: First, define the role of assisted livings clearly for consumers, families, regulators and policymakers. Second, improve assessment and transparency so residents are matched with the right setting, and families understand what services are and are not included. Third, support training and competency requirements that improve care without turning every assisted living community into a skilled nursing facility. Fourth, build a real workforce plan for long-term care before imposing new staffing obligations. Finally, preserve what assisted livings were intended to provide: a home, not an institution.
The goal should not be to make assisted living more institutional. The goal should be to make Minnesota’s entire continuum of care work better—home care, assisted living, memory care, skilled nursing and family caregiving—so older adults can receive the right care in the right setting at the right time.
Assisted livings are not failing because it is not a nursing home. It is being strained because Minnesota is increasingly expecting it to function like one without saying so, funding it or planning for the workforce required. Older Minnesotans deserve safety and quality. They also deserve choice, dignity, privacy and a place that still feels like home. Those values should not be regulated out of existence.
Toby Pearson | President/CEO |
[email protected] | 952-851-2487