A few of Colorado’s approximately 600 assisted living facilities (ALFs) have occasionally been in the news due to investigations that found lapses in care quality or other issues. Individuals considering ALFs and their caregivers thus have a keen interest in knowing how ALFs are monitored, reviewed, and regulated with the goal of assuring the best quality care and service.

We recommend a good place to start is by reading our AgeWise Colorado article at

https://agewisecolorado.org/blog/trends-in-assisted-living-populations-in-colorado/. It contains a considerable amount of information on Colorado ALFs, including advice on how to select one.

In addition, you may want to check out this website of the Colorado Department of Public Health and Environment (CDPHE): https://cdphe.colorado.gov/find-and-compare-facilities. CDPHE regulates all assisted living facilities in the state. All ALFs must comply with the regulations set forth by this department to remain in operation. Both scheduled and unscheduled checks are performed to verify facility compliance.

The CDPHE site offers a dashboard that enables you to search for and view the results of any inspection conducted within the previous 5 years for any healthcare provider currently licensed by CDPHE, state-certified by the Colorado Health Care Policy and Finance, or federally certified by the Centers for Medicare and Medicaid Services. On this site you can see citations identified during ALF inspections, the requirements or practices to be met, as well as the plan of correction submitted by the provider indicating how the citation was remedied. You will also be able to view all occurrence reports submitted within the last 3 years. CDPHE says an “occurrence” refers to any of a number of different problematic events that healthcare providers are required to self-report.

Additional specifics about the operation of Colorado ALFs include the following:

Service Plans in Colorado Assisted Living Communities

Prior to resident admission, Colorado assisted living facilities must perform a careful evaluation of every potential resident’s care needs. This includes their level of independence and types of care needed. These evaluations factor in the social, cultural, and religious needs of each resident. This evaluation helps determine whether the facility in question can meet the potential resident’s care needs.

Admissions at Colorado Assisted Living Communities

Among admission requirements that must be met is a signed resident agreement. Admission can be disallowed for certain conditions, such as a resident who: •  Requires 24-hour medical care • Has unmanageable illnesses • Has incontinence that cannot be managed by staff • Has stage 3 or 4 pressure sores • Has certain mobility restrictions • Has a history of conduct that might pose danger to others • Needs restraints.

Medicaid Policy at Colorado Assisted Living Communities

Colorado’s Medicaid program, known as Health First Colorado, covers some costs associated with Medicaid-certified assisted living communities for residents who are Medicaid beneficiaries. It is estimated that about 27% of Colorado’s ALF residents receive Medicaid benefits. Activities of daily living are covered, but residents must cover room and board and may have to contribute to other costs. Waivers may be available to help with assisted living costs not covered by Health First. (See details on waivers at https://hcpf.colorado.gov/hcbs-waivers.)

Physical Facility of Colorado Assisted Living Communities

There are a number of facility requirements Colorado ALFs must meet. Exterior areas must be well-maintained and stairs lit after dark. There can be no more than two residents per room for facilities licensed since 1986. Facilities must have a minimum of one full bathroom per six residents. Full bathrooms must contain a toilet, sink, shower, mirror, and toiletry storage area. Tubs and showers must be equipped with grab bars.

Medication Management at Colorado Assisted Living Communities

Assisted living facilities can allow only authorized nurses, practitioners, certified nurse medication aides (CNA-Meds), or a qualified medication administration person (QMAP) to administer resident medications. Residents must be capable of consenting to and taking medication in order for CNA-Meds or QMAP professionals to provide medication assistance.

Staff Training at Colorado Assisted Living Communities

Colorado ALFs are required to have set policies and procedures for all staff. Information on responding to altercations and missing residents must be included. Staff training includes information on the facility, where residents are allowed and restricted, and the mobility ability of each resident. Security devices and override procedures are also covered through staff training. Each staff member is trained on care provisions for each resident, and staff training must be recorded. As noted in our AgeWise Colorado article, specific training in dementia care is required for ALF staff beginning January 1, 2024.

Background Checks in Colorado Assisted Living Communities

ALFs must conduct a criminal background check if there is any indication that a staff member, administrator, or volunteer could risk the well-being, safety and/or health of facility residents. Pre-employment background checks can be performed as part of the hiring process if desired by the facility administrator.

Reporting Abuse for Colorado Assisted Living Communities Residents

If resident abuse is suspected or confirmed, it must be reported to the facility administrator and the local Department of Social Services within 24 hours of the allegation.

How ALF Information can Help Coloradans

If and when you are considering a Colorado assisted living facility, you can use the above information as part of your evaluation checklist. Find out if all the regulations are followed in the ALF you are looking into. If interested, you can view the full Code of Colorado Regulations governing assisted living facilities at https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=9550.

Note that following media investigations of neglectful care in the state’s ALFs, the Colorado Board of Health dramatically increased financial penalties for documented lapses in care. This is designed to hold facilities accountable and also to incentivize facilities to maintain a high and consistent level of care for their residents. The investigations had found approximately 110 deaths in Colorado ALFs that were classified by the state as “unexplained or suspicious.” It’s important to note that not all of these events were confirmed to be due to care neglect. For perspective, it is also worth noting that the investigations covered a period of four-and-a-half years, and it is estimated that Colorado ALFs have a cumulative licensed capacity for roughly 15,000 residents.