Assisted Living Service Plan Requirements

Assisted living facilities in Colorado are required to have a written care plan for each resident that is reviewed at least annually. These plans must be based on a complete assessment that evaluates health, behavioral, social and physical needs and strengths. Care plans should also outline whether a senior:

• self-administers medication or needs help from staff
• needs assistance with any activities of daily living
• has activity restrictions ordered by their doctor
• has any dietary needs or restrictions

Assisted Living Admission Requirements

Assisted living facilities in Colorado cannot admit residents who are consistently and completely incontinent unless the resident or the facility’s staff can ensure that it doesn’t become a health hazard for other residents. Facilities cannot admit residents who are entirely bedridden with limited potential for improvement, require 24-hour skilled nursing care, have an acute substance abuse problem, have a communicable disease or are in need of restraints.

If a current resident becomes bedridden, they may continue living in the community if there are enough staff members trained in meeting the needs of bedridden residents, a licensed hospice of home health service ensures that the resident's physical, social and emotional needs are met, and a physician outlines the care services the resident needs.

An assisted living facility cannot admit a resident who needs hospice care. However, long-term residents may receive hospice care in an assisted living facility if the community’s staff have been trained to provide hospice care and doing so will not compromise the care that the other residents receive.

Assisted Living Scope of Care

Assisted living facilities in Colorado are required to provide supervision and protective oversight for residents in a safe and sanitary environment. The facilities must offer assistance with the activities of daily living, transportation and opportunities for socializing and recreation.

Facilities are required to deliver three meals and between-meal snacks every day. Residents should be encouraged to help with meal planning. Therapeutic diets may be offered if a physician has ordered them.

Assisted Living Medicaid Policy

In Colorado, assisted living facilities that accept Medicaid are called alternative care facilities, or ACFs. The state provides assisted living service under two Medicaid Waiver programs:

• Home and Community-Based Services Waiver for Community Mental Health Supports, which is for seniors, adults with physical or mental disabilities or illnesses and those with AIDS or HIV
• Elderly, Blind and Disabled Waiver

Assisted Living Facility Requirements

In Colorado, facilities are not required to offer apartment-style units. Facilities built after July 1, 1986, can have a maximum of two occupants per bedroom. There must be one full bathroom for every six residents. Cooking is not allowed in the bedrooms, so in facilities that do not have apartment-style units, a food preparation area for heating and reheating food or making hot beverages have to be provided. Access and use of the food preparation area are subject to the facility’s rules, and only residents who can cook safely are permitted to do so.

Medication Management Regulations

Staff members who assist with administering medication must pass an approved medication course given by a licensed nurse, physician, physician’s assistant or pharmacist, or they have to pass an approved competency test for administering medications. A qualified medication administration person, or QMAP, may administer prescribed and over-the-counter medications, but they may not administer medications via a syringe for injection under the skin or into the bloodstream.

Assisted living facilities are required to keep a copy of the QMAP certificate in the employee’s file. A person who is certified as a QMAP must take a competency test every five years.

Staffing Requirements

Every assisted living facility in Colorado must have a full-time administrator who oversees day-to-day operations and staffing. There has to be at least one QMAP and at least one staff member who has a current certification in adult first aid on site at all times.

While the state has no minimum staffing ratios for facilities that do not accept Medicaid as payment, each assisted living facility should have its own method of determining how many staff members it needs on duty. This includes whether or not the facility has an awake staff 24 hours a day. The expectation is that there will be enough staff members on duty to provide adequate care for residents’ scheduled and unscheduled needs.

Staff Training Requirements

Administrators are required to complete 30 hours of training: fifteen hours covering topics such as residents’ rights, fire safety, emergency procedures, nutrition, and identifying and addressing challenging situations and behaviors, and an additional 15 hours of training covering the personal, social and emotional needs of residents, including medication management, chronic illnesses, the use of community resources and end-of-life care.

Staff members must be given on-the-job training or have relevant job experience for the duties assigned to them. Before staff members can provide direct care for residents, they have to receive training on residents’ rights, first aid and injury response, the facility’s medication administration program and other needs specific to the facility’s residents.

Within one month of employment, staff members must receive training on assessment skills, health emergency response, and identifying and handling difficult situations.

Background Checks for ALR Staff in Colorado

Owners and administrators must undergo a fingerprint background check. Owners are responsible for conducting criminal background checks on administrators to ensure they have never been convicted of a felony that could pose a risk to the safety and well-being of residents. All staff must have criminal background checks, including permanent staff, volunteers and contract staff.

Requirements for Reporting Abuse

In Colorado, everyone who is employed by an assisted living facility in any capacity is a mandated reporter. This means they are required by law to report any abuse, neglect or exploitation they see or have reason to suspect. All reports should be made to their local law enforcement agency.