Committee hears changes to adult foster‑care rules: more respite time, 12‑hour substitute shifts and limits on provider-initiated video monitoring

The Senate Human Services Committee took testimony on House Bill 1460, which would change respite, substitute‑care and monitoring rules for licensed adult foster care homes. Representative **** Anderson (District 6) described constituent concerns from rural providers and sought statutory changes to make independent adult foster homes more workable in remote communities.

Representative Anderson said one provider asked to allow substitute caregivers to work 12‑hour periods rather than an 8‑hour cap so long drives and staffing gaps in rural areas would be simpler to manage. Anderson also said providers asked for a different count of allowable respite days during a two‑year period — testimony referenced moving from the current limit (96 calendar days in two years, as represented in current practice) toward a higher allowance so providers could take more regular time off.

Nancy Nicholas Meyer, director of Adult and Aging Services at the Department of Health and Human Services (DHHS), proposed a narrower amendment concerning electronic monitoring. Meyer told the committee the federal Medicaid home‑and‑community‑based‑services (HCBS) settings rules require residents who receive HCBS to be afforded privacy in their living units. DHHS recommended removing language that would allow a provider to install a “video transmitter” in a resident’s private unit, because federal guidance does not treat a provider‑installed video camera as consistent with the privacy expectation. Meyer said the HCBS rules do allow one‑way audio transmitters or similar assistive devices, and DHHS would prefer language that leaves monitoring decisions to the resident, the resident’s legal representative, or the resident’s family.

Jessica Nelson, a licensed adult foster home provider who operates Prairie View Inn Senior Living Home in rural Towner, testified about the hands‑on, family‑based nature of adult foster care and described the practical challenges of providing 24‑hour care while maintaining family life. “An adult foster home is families helping families,” Nelson said. She described building a two‑unit accessible home so her family could live on‑site while caring for up to four residents and said much of the demand she sees is for residents with dementia and cognitive impairment. Nelson told the committee the current interpretation of the rules had at times limited her ability to hire paid help to assist with direct care; DHHS witnesses said providers may seek case‑specific modifications through formal care‑plan processes.

Committee discussion focused on two areas: how to balance private‑pay and publicly funded residents under differing HCBS rules, and the privacy and safety tradeoffs for monitoring residents with cognitive impairment. DHHS staff said there are 11 adult foster homes in North Dakota serving about 15 people; nine of those residents are enrolled in state or federal HCBS programs. DHHS proposed that monitoring be allowed if the resident (or, if incapacitated, the resident’s legal representative or family) approves in writing, but that a provider cannot unilaterally install a video transmitter in an HCBS beneficiary’s private sleeping unit.

No formal committee action was recorded during the hearing. Committee members said they would continue the conversation with DHHS and providers and asked staff to convene a post‑session work group to consider rule changes and implementation issues for the unique adult foster‑care population.

What the bill would change (as described in testimony): allow substitute caregivers to work 12‑hour shifts (instead of the current 8‑hour threshold for counting respite), increase the number of allowable respite days within a 24‑month window (exact statutory language and final counts to be negotiated), clarify that DHHS licensing applies to private‑pay and public‑pay adult foster homes, and limit provider‑initiated video monitoring where federal HCBS privacy rules apply.