Assisted Living in Colorado

Agency: Department of Public Health
Phone: (303) 692-2800
Website: www.healthfacilities.info

Assisted living residences are residential facilities that make available to three or more adults who are unrelated to the owner, either directly or indirectly through an agreement between the provider and the resident, room and board and at least the following services: personal services; protective oversight; social care due to impaired capacity to live independently; and regular supervision that must be available on a 24-hour basis, but not to the extent that regular 24-hour medical nursing care is required.

Facility Scope of Care:
The facility must make available, either directly or indirectly, through a resident agreement the following services sufficient to meet the needs of the residents: a physically safe and sanitary environment; room and board; personal services; protective oversight; and social care.

Move-In/Move-Out Requirements:
A facility shall not admit or keep any resident requiring a level of care or type of service that the facility does not provide or is unable to provide (and in no event shall a facility admit or keep a resident who is consistently uncontrollably incontinent unless the resident or staff is capable of preventing such incontinence from becoming a health hazard); is totally bedridden with limited potential for improvement; needs medical or nursing services on a 24-hour basis; needs restraints; has a communicable disease or infection unless the resident is receiving a medical or drug treatment for the condition and the admission is approved by a physician; or has a substance abuse problem unless it is no longer acute and a physician determines it is manageable. A facility may keep a resident that becomes bedridden while residing in it if there is documented evidence of the following: an order from a physician describing the services required to meet the resident's health needs (including the frequency of assessment and monitoring by the physician or other licensed medical professionals); ongoing assessment and monitoring by a licensed or certified home health agency or hospice (at least weekly assessment); and adequate staffing by individuals trained in the provision of care to bedridden residents.

Resident Assessment:
There is no standard required assessment form. However, the regulations require a comprehensive pre-admission assessment of the residents' physical, health, and social needs, preferences, and capacity for self care.

Medication Management:
All personal medication is the property of the resident and no resident shall be required to surrender the right to possess or selfadminister any personal medication, except as otherwise specified in the care plan of a resident of a facility that is licensed to provide services specifically for the mentally ill, or if a physician or other authorized medical practitioner has determined that the resident lacks the decisional capacity to possess or administer such medication safely. For residents who are unable to self-administer medications, medications must be given by a qualified medication administration staff member who has completed a state-approved training and competency examination. A qualified medication aide is permitted to administer oral, inhalant, topical, vaginal, and rectal medications, but not injections. If donated by a resident or resident's legal representative, a facility may return unused prescription medications that are not controlled substances to a pharmacist in accordance with state laws.

Physical Plant Requirements:
Private resident units must be a minimum of 100 square feet and double occupancy resident units must provide a minimum of 60 square feet per resident.

Residents Allowed Per Room:
A maximum of two residents is allowed per resident unit. In facilities licensed prior to July 1, 1986, up to four residents are allowed per room, until either a substantial remodeling or a change of ownership occurs

Life Safety:
Current life safety-related regulations for Colorado's Assisted Living Residence program became effective May 30, 2004. All new requests for licensure require compliance with the National Fire Protection Association (NFPA) Life Safety Code, 2003 edition, Chapter 32, New Residential Board and Care Occupancies. The chapter addresses both small facilities (16 beds or less) and large facilities (17 beds or more). Automatic sprinklers and smoke detection are required, per the Life Safety Code, in these facilities. Automatic sprinkler systems utilizing antifreeze are not allowed in new facilities. Existing facilities are required to meet the 2003 Life Safety Code, Chapter 33, Existing Residential Board and Care Occupancies, or NFPA 101A Guide on Alternative Approaches to Life Safety (2004 edition). Requirements for sprinklers, fire alarm systems, and smoke detection systems are dependent upon a facility's level of evacuation capability.

Alzheimer's Unit Requirements:
Secured units for the purpose of serving residents with Alzheimer's disease are allowed and additional requirements are set forth in the regulations.

Staff Training for Alzheimer's Care:
Staffing must be adequate and staff must be trained to meet residents' needs. For those facilities choosing to provide secured care, at least one trained staff member must be in the secured unit at all times.

Staffing Requirements:
Staffing must be adequate to meet residents' needs. In Adult Congregate Living, the staffing ratio is one to six.

Staff Education Training:
Staff shall be given on-the-job training or have related experience in the job assigned to them. Prior to providing direct care, the facility must provide adequate training on specific needs of the population served (e.g., residents in secured environments, severely and persistently mentally ill, frail elderly, AIDS, Alzheimer's disease, diabetics, dietary restrictions, and bedfast); residents' rights; first aid and injury response and procedures for providing lift assistance; the care and services for the current residents; and the facility's medication administration program. Within one month of hire, the facility must provide adequate training on assessment skills; infection control; identifying and dealing with difficult situations and behaviors; and health emergency response. There must be one staff member onsite at all times who has current certification in adult first aid that meets the standards of the American Red Cross or American Heart Association

Medicaid Policy and Reimbursements:
A Medicaid home and community-based services waiver covers services in alternative care facilities. Facilities are reimbursed on a flat rate based on residents' income.