Colorado Springs’ daily newspaper, The Gazette, on July 9th published the results of its four-month investigation into what it describes as “troubled deaths” that have occurred in the state’s assisted-living facilities. The paper said its investigation revealed that “preventable deaths at facilities promising a watchful eye happened more often than the public knows.”
In filling out the details behind that assertion, The Gazette included a number of facts and figures its research uncovered, along with allegations made by people affected and rebuttals offered by facilities and by public and private agencies involved. Following are several of the key points the article made.
Colorado documented 110 unexplained deaths in Assisted-Living Facilities
Between January 1, 2018 and October 22, 2022, there were 110 documented deaths classified by the state as “unexplained or suspicious” at assisted-living facilities (ALFs). This is according to the Colorado Department of Public Health and Environment (CDPHE) records — records that come from mandatory self-reporting ALFs must do.
How Colorado classifies “deaths”
“But in addition,” The Gazette stated, “analysis of more than 4,500 reports plus independent reporting discovered three-dozen more deaths or incidents of neglect and abuse that later led to death. In some of those cases, the deaths were found within state records classified as something other than death.”
How might this happen? CDPHE says ALFs are required to report problems or complaints to the state, technically known as “occurrences,” to capture serious issues. But “occurrences” can be classified in various categories such as death, neglect, abuse (physical, verbal, or sexual), misappropriation of property, drug diversion, or medication errors. To be counted as a death, CDPHE says, the loss of life must be “reportable to the coroner as unexplained or suspicious.” In addition, said The Gazette, “Under the current system an occurrence can only be logged under one category, and facilities determine the category when submitting to the state.” CDPHE then reviews the submission to ensure it fits the details of the situation.
Examples of unusual classifying of Coloradans’ deaths
As an example of the possible flaw in the system, among the additional three-dozen deaths The Gazette found in its probing of records was that of an 86-year-old woman who died in 2021 after being trapped outside her ALF memory unit for six hours in temperatures topping 100 degrees. Even though it was later learned that staff at the unit falsified records to make it appear the patient had been properly checked on and two of them pled guilty to charges and served some jail time, CDPHE formally classified the case as “neglect” rather than “death.”
In another case, in 2018, an elderly man died after not getting his medication and overnight oxygen for several days. It was classified as “neglect,” not “death.” In 2021 an elderly woman was force-fed by a staff member until she began violently vomiting and was found dead the next morning in her bed, possibly due to aspirating her vomit. This was classified as “physical abuse,” not “death.”
Advocates cite lack of penalties in Colorado in Assisted-Living Facilities
In talking to advocates for older adults, The Gazette found they say that most of the time the assisted-living model works well and fills an important need when people can no longer live independently. “But,” the paper went on to say, “they also say the lack of substantial penalties in Colorado when things go wrong points to a systemic failure to protect its most vulnerable seniors.”
A spokesman for the Colorado Attorney General’s Office said formal charges in abuse, neglect or death cases can be filed only if the elements of a chargeable crime are established and if the responsible person can be shown to have committed the offense. So enforcement action often falls to the CDPHE, which has limited muscle. The agency can suspend a facility’s license, but The Gazette says that has happened just five times since 2019. There’s an intermediate step the state can take, that of issuing a “conditional” license, which requires an enhanced level of monitoring and stricter rules as incentives to have the facility come into compliance. The Gazette says CDPHE has issued 31 conditional licenses since 2019.
According to the newspaper’s report, under current state law the maximum fine for violations is $2,000. That maximum is per year per facility no matter how many violations there might be. And the fine could be less. It’s a fine structure currently so low a national expert called it “absurd.” The Gazette cited one instance in which a patient froze to death at a facility that had received eight citations, and the total fine was $1,500. In a similar case where a patient froze to death, the facility received one citation and no fine at all. No criminal charges were filed in either case. (In its research, The Gazette identified six cases of hypothermia alone at ALFs, four of them fatal.)
Legislative efforts have been made to substantially increase fines for violations, but The Gazette noted that LeadingAge Colorado, “the largest association of senior living care providers in the state,” calls higher fines “ill-advised.” A LeadingAge spokesperson was quoted as saying, “There’s no real research out there that increased fines improves quality of care.” But Shannon Gimbel, ombudsman manager at the Area Agency on Aging for the Denver Regional Council of Governments, was quoted otherwise as saying, “Until there is a real consequence — or the fear of a consequence — nothing is going to change. We can no longer excuse these deaths as accidents. They are homicidal negligence.”
Colorado’s need for assisted living expected to grow
The Gazette observes that despite explosive growth in the assisted-living industry in recent years, ALFs — unlike nursing homes — have no direct federal oversight. Regulation is left to individual states. “In Colorado, administrators do not have to be licensed as they are in nursing homes,” the paper notes. “And the qualifications for assisted-living staff — often paid little more than minimum wage — are also less stringent than those in nursing homes, because it is assumed residents do not need as much hands-on attention. In recent years, though, the original [ALF] model has evolved to offer higher levels of care, especially for those in memory units.”
According to the 2020 U.S. Census, Colorado has the nation’s third-fastest population growth rate of people ages 65 to 84, and that age cohort is projected to grow by another 265,000 in the next decade. There are reportedly about 665 assisted-living facilities licensed in Colorado, many of them small. That’s 100 more than a decade ago. ALFs now outnumber licensed nursing homes by nearly 3 to 1, according to state data.
Nationally, ALFs represent nearly a $100 billion market. In Colorado, the cost of assisted living is now roughly $5,000-$7,000 per month. At some facilities, it can exceed $10,000. The bulk of this expense is not covered by traditional health insurance or Medicare. And Medicaid is accepted only with strict qualifications.
How Coloradans can enhance safety in exploring assisted living
What can consumers do to navigate the assisted-living picture with as much confidence and safety as possible? A good place to start is by reviewing the article discussing ALFs on our AgeWise Colorado website at https://agewisecolorado.org/blog/important-news-about-assisted-living-in-colorado/. There you will find ways to evaluate facilities, how to choose the right one for your specific circumstances, and other helpful information. Another useful resource is Colorado’s long-term care ombudsman at https://cdhs.colorado.gov/about-cdhs/performance-outcomes-and-reviews/ombudsman-offices/long-term-care-ombudsman. There you can learn a great deal about long-term care options, read reviews of facilities and obtain guidance on selecting one, and more. Should you ever encounter an adverse situation in a Colorado ALF that you believe needs to be addressed, you can file a complaint at https://cdphe.colorado.gov/health-facilities-complaints.
