Health Commissioner Jan Malcolm on clearing the state's backlog of elder abuse complaints

The Minnesota Department of Health is finally caught up on its towering backlog of elder abuse complaints. At the beginning of this year, more than 3,100 reports awaited investigation by the state Office of Health Facility Complaints — evidence of a longtime crisis called out in a Star Tribune series last fall.

Governor Dayton sent the Department of Human Services in to help the Health Department move through its caseload, and modernize the department's system. MPR News host Cathy Wurzer spoke with state Health Commissioner Jan Malcolm about what's changed, and how all those complaints have been handled.

Comments have been edited for clarity and length.

I think there are some folks hearing this news who might say you can obviously open and close an investigation into a complaint of elder abuse, but a really in-depth review takes some time. So what do you tell Minnesotans, how do you reassure them that your progress through this huge backlog has been thorough?

Well, it's a very fair question. And the key to our process is on the front end of the process: triaging those complaints, about 400 a week that continue to come in, so that the most significant complaints representing a clear risk or ongoing risk to elders and vulnerable adults, that those are investigated first. So all complaints, all cases are not the same, obviously. That's pretty common sense. So what we're really proud of is that in addition to clearing that backlog, every single complaint now has eyes on it within two days, to assess the severity of that complaint.

So we're triaging much more appropriately, much more efficiently. And then a lot of the complaints frankly don't rise to the level of abuse and maltreatment as defined in state law. They may be other kinds of quality service complaints, other concerns, all of which are important. And we want to do a much better job, going forward, of using all that data that we collect, even if investigations don't result in a substantiated finding of abuse or neglect. That's still a lot of data that we can do a lot more with to improve the system overall.

How long at this point does it take from when a complaint is filed to when it's closed, under the new system?

Well on average, we are now able to answer everything and fully investigate and close an investigation within the state deadline, which is 60 days, is the statutory goal.

That's on average. The range is quite a bit broader, so we're tracking those data really, really closely, and continue to make improvements to close all cases within that 60-day window. We're not there yet, I'll be quite straightforward about that.

It seemed that much of the problem was a lack of, simply, bodies to do the investigation, and also it came as a surprise to many people that paper case files were being used prior. So let's address these two issues. Once the Department of Human Services I would presume takes leave, do you have the bodies then to adequately do the investigations?

Well, and I do thank you for mentioning again the Department of Human Services. Their partnership has been terrific, and that is another part of how we got through this big backlog. We had additional very highly-trained staff from DHS helping us to process this backlog and helping us to design new work processes to just make the whole thing more efficient.

DHS actually has already kind of turned over the ongoing management of the program back to us. That happened on July 1, well ahead of schedule, and that's great, thanks to them and the hard work of our staff. So your question about adequate staffing — that continues to be a challenge. We are continuing to add staff. It's a tight labor market and this is a competitive industry, and the type of folks who do these complaints often have many opportunities inside and outside the state government.

But yes, we're making progress staffing up the function, and it is a much more efficient function because of the automation of some of the processes. We did have a paper-based system for receiving and handing off complaints. One of the big keys to our improvement was a new what's referred to as an electronic document management system, that automates at least the front end of that process, and allows us to track where is a complaint in the process.

I'll have to say, and this is a little technical, I suppose, that is not the same thing as a full robust electronic case management system, which the legislature and the Office of Legislative Auditor are very eager for us to do, and we are, too. We're very eager to build a more robust full case management system. That will take going back to the Legislature and seeking funding for that next year. But we have automated — sort of on an interim basis with interim tools — much of this process, which has made it just vastly more efficient.

So clearing the backlog of complaints clearly was a huge undertaking. And as you mentioned at the beginning of our conversation, there's still about 400 complaints coming in every week, which would seem to indicate, perhaps, little resolution of the underlying issues brought to light by the Star Tribune investigation. So, with no action taken by the Legislature this past session on elder abuse, what's the department doing to deal with some of these underlying issues?

Well, we continue to work with partners, consumers, folks in the long-term care industry, legislators to try to deepen the agreement on what are those underlying policy solutions. We very much hope and intend to come back at this with legislative solutions next year, and I think that agreement is possible to be reached.

I do think there's broad agreement now that we need to fill some of the gaps in our regulatory system where assisted living settings — which is where the majority of our elders and vulnerable adults now live — aren't regulated at all. And that's a big hole in the system, so that's one thing we're working on. Also, I think we can do more, and [we] are working with the Office of the Ombudsman for Long-Term Care and with community resources, [the] Elder Justice Center and others, to educate consumers and families on what their rights are currently, and how best to resolve issues before they get to a crisis stage.

So I think there are improvement opportunities literally all along the continuum here, from working with facilities on process changes, helping consumers and working with the Legislature on filling in, as I said, the gaps in this regulatory framework.

Alright. Commissioner Malcolm, thank you so much.

Thank you, Cathy.