Frequently Asked Questions

I am thinking of starting a small assisted living home for 8 residents...

Can you recommend any books to describe this business I could read?

Does Colorado have specific regulations for assisted living centers; if so, what is the website?

Do all rooms need an indoor fire sprinkler system, for instance?

Are there bonding or background check requirements for employees?

Is there a website to post job openings?

 

Answer:

There are three types of assisted living residences in Colorado: private pay, alternative care facilities (assisted living residences that are Medicaid certified) and residential treatment facilities for persons with severe and persistent mental illness. There are over 530 assisted living residences in Colorado. Any assisted living residence caring for 3 or more residents must be licensed.

The best place to start is by reading the regulations that govern the type home that you are looking to open. These can be found at the Colorado Department of Health website:

http://www.cdphe.state.co.us/hf/alr/index.html.

To answer your more specific questions:

“Are there any books?”

I have not seen a “good” manual that will help you with opening this type or business, there are owners in the business that will consult with you and walk you through doing this, this is usually a fee-based service.

Does Colorado have specific regulations?

Yes, see link above.

Do all rooms need an indoor fire sprinkler system?

Yes, the whole house must have alarms and sprinklers, see regulations cited in link.

Are there bonding or background check requirements for employees?

Yes, including the owners, relegations go into great detail.

Is there a website to post job openings?

The CALA website has a place to post job openings.

The State also requires owners and/or operator to attend an approved 30 hour administrator training class. There are at least two members of CALA that teach these classes.

Thomas Kinrade

President, Colorado Assisted Living Association

www.coloradoassistedliving.com

www.cala-co.org

What are Colorado regulations for Volunteers in Assisted Living Communities?

When we have a volunteer apply to volunteer what are the state requirements (Back ground, Drug screen, t.b. ext)?

Answer

They do need to have a TB test and the regs are as follows.

Chapter 7 says 104(3)(c)

The staff who has direct personal contact with the residents of a facility and any volunteer performing personal services or protective oversight, under the auspices of the facility for residents of such facility… shall obtain any criminal history record information from a criminal agency.

104(3)(f) says Volunteers providing direct care shall receive training appropriate to their duties and responsibilities.

104(4)(c) says Volunteers may be utilized in the facility but may not be included in the facility’s staffing plan in lieu of facility employees.

Nothing in Chapter II or the ACF 8.495

If you need any more clarification please let us know.

CALA Staff

Can I charge a non-refundable security deposit for residents in a assisted living facility?

Answer:

Below are the applicable rules from HCPF for ACFs, so when you read through it, particularly the last section, it is not permissible to collect a security deposit for ACF clients. There are some ALRs that will charge a move in fee or community fee that is non-refundable.

For Private Pay facs and private pay residents, they can ask for a security deposit as long as it is disclosed in the written agreement. Here is that regulation in Chapter VII: 1.105(2) Resident Agreement. A written agreement shall be executed between the facility and the resident or the resident’s legal representative at the time of admission. The parties may amend the agreement provided such amendment is evidenced by the written consent of both parties. No agreement shall be construed to relieve the facility of any requirement or obligation imposed by law or regulation. 105(2)(a) Content. The written agreement shall specify the understanding between the parties regarding, at a minimum the following: (i) charges, refunds and deposit policies;

Here are the ACF rules, and this guidance comes from our HCPF friends:

C.R.S. Section 25.5-4-301(1)(a)(1), states “Except as provided in section 25.5-4-302 and subparagraph (III) of this paragraph (a), no recipient or estate of the recipient shall be liable for the cost or the cost remaining after payment by medicaid, medicare, or a private insurer of medical benefits authorized by Title XIX of the social security act, by this title, or by rules promulgated by the state board, which benefits are rendered to the recipient by a provider of medical services authorized to render such service in the state of Colorado, except those contributions required pursuant to section 25.5-4-209 (1).”

8.012.2.A. Providers are explicitly prohibited from collecting payment, or attempting to collect payment through a third party, from a recipient or the estate of the recipient for the cost or the cost remaining after payment by Medicaid, Medicare, or a private insurer of Medicaid covered items or services rendered to Medicaid recipients.

8.012.2.B. Providers shall be liable to a recipient or the estate of the recipient if the Provider knowingly receives or seeks collections through a third party of an amount in payment for Medicaid covered items or services.

8.012.2.C. Providers are prohibited from collecting, or attempting to collect, payment from recipients for Medicaid covered items or services regardless of whether Medicaid has actually reimbursed the Provider and regardless of whether the Provider is enrolled in the Colorado medical assistance program.

8.012.2.D. Providers shall be liable for the amount unlawfully received, statutory interest on the amount received from the date of receipt until the date of repayment, plus a civil monetary penalty equal to one half of the amount unlawfully received.

8.076.1.7.k.-The Provider has solicited or accepted from an eligible client, his or her family, friend, estate, or other representative an amount over and above the Medical Assistance program reimbursement amount for covered goods or services, excluding any required co payment, coinsurance, or other client cost-sharing amounts.

Can assisted living in Colorado use mechanical lifts?

Are assisted livings in Colorado permitted to use mechanical lifts such as a hoyer lift?

Answer:

Yes lifts are allowed. Many communities own and use them. The key is having the correct training for the staff on how to use them and how to conduct lifts properly.

Of course you should always check with the state regulations and the compliance department at the state.

CALA Staff

Will I lose my home if I choose assisted living?

I own my home free and clear and would like my children to have it if I go into assisted living. Will I have to sell my home to pay for assisted living or is the cost based on my income only?

Answer:

The answer to your question really depends on several factors.

First of all the cost of assisted living is not determined by your income. Every assisted living community has their own services they provide and decide the fees they charge for those services. No two communities are the same.

The real challenge is determining how you will pay for assisted living based on your own income and financial situation.

You can also talk to tax and financial planners to determine the best course of action in order to accomplish your goals for your home and your financial situation in the future.

The only time your income and assets come into determining the care you receive is if you apply for Medicaid to pay for your living and health care expenses. Again you should talk with financial advisors or to the Medicaid program directly to determine their requirements which are very specific as to your assets and income

There is no assisted living community that requires you to give up your home in order to live in their community.

 

In Colorado does a staff need to be awake during the night at a small 8 client assisted living home?

If just available, what does that mean, a call button?

Answer:

It really can vary depending on the needs of the residents in the home. Many small homes do allow for the caregiver to sleep but they are always close by and on call.

Things like motion alarms are used on doors, floors, etc. that will go off as well as call buttons that can wake the caregiver.

You can refer to the state regulations and ombudsman as well for any specific requirements again depending on the residents needs.

http://www.colorado.gov/cs/Satellite/CDPHE-HF/CBON/1251583470236

Is there a state or federal regulation prohibiting bed rails?

Is there a state or federal regulation prohibiting bed rails and/or fall mats in an assisted living residence?

Answer:

There are no state regs in assisted living prohibiting bed rails however in my experience I would not consider them best practice to use them. The reason that they are not safe lies with the risk they present to the resident falling out of bed, being tangled in their sheets/bed rails and the possibility of strangulation. Many facilities may have a policy against bed rails. So in that case the state could write a deficiency for the facility not following their own policy (if the state were to find bed rails in use).

The alternative would be to have the resident use a bed cane and obtain an order from the primary care physician for occupational therapy. The resident can then learn how to use the bed cane safely and efficiently with the goal to maintain as much independence for that resident as possible. The state would be pleased to see that action taken, aside from the fact that it is making the resident’s home safer for them.

Fall mats are okay, but whatever assistive devices are in use in the community MUST be care planned for that specific resident and you must have documented training on those devices for your staff.

How to get proof of Colorado QMAP certification?

I am trying to get proof of my Qmap certification for a current employer.

Do you have any information on how I can attain that?

Answer:

The Colorado Department of Health keeps those records on file.

To get your certification for QMAP go to.

QMAP Verification Search

You can also contact Val Peake at veldine.peake@state.co.us.

Either way you will be able to get the verification of your QMAP qualifications.

CALA Staff

What happened to legislation to move people from nursing home to AL?

Corky – I know a bill was introduced in the past session that would move Medicaid residents out of a nursing home and into an Assisted Living at the rate of $3,000/mo. in order to save money. Did it pass and if so what is the implementation date? Thanks Michaelle Smith – Hilltop Grand Junction

Answer:

This bill was passed and will be signed by the Governor on June 4th

The real work will not begin working with the regulatory part of the Health Department to implement the program

To keep up to date on the progress please be sure you are subscribed to CALA emails and have your membership investment up to date.

CALA Legislative Committee

How do you keep a walker with an Alzheimer patient, who keeps walking away from it and loves to walk around?

Have tried a sign to tell her to keep it with her to no avail even named it. The house is small and has rails down halls but still wobbly.

Answer:

You might want to consult with an OT, or another safety specialist of the like. Honestly, “you don’t” is the short answer. You walk with her, you have the family sign a managed risk agreement, you do your best to keep her safe, but there’s no way to prevent falls in all circumstances.

Can a RN practice as a Qmap in Colorado?

I JUST WANT TO KNOW IF A RN IS ABLE TO PRACTICE AS A QMAP IN A ASSISTED LIVING SETTING?

Answer:

That has some questionability: if someone is an RN, why aren’t they practicing? As an RN, they’re not able to be supervised by an LPN (that’s a nursing rule). If their RN license is from another state or has lapsed, they should be able to get a QMAP. I’d check their records with the nursing board and maybe touch base with CDPHE to be sure.

Can you please recommend a couple options for QMAP classes/instructors in the Denver area?

We have a new employee that we need to get through the class .

Answer:

The only list that we have access to is what is provided by the CDPHE.

Here is a link to their website that will have a document showing all the instructors and classes that are coming up.

https://www.colorado.gov/pacific/cdphe/medication-administrationqmap

Wish we could provide more information but at this time that is all we have.

CALA

How often do I need to re-new my QMAP certifications in Colorado?

Answer:

QMAP programs are a little different depending on which specific industry you are in. Assisted Living has different standards than Nursing Homes, etc.

For assisted living your QMAP certification is good for 5 years. At that time you need to go through the QMAP training again and take a test to be re-certified.

CALA has been working closely with the state health department to make this process very practical and to not make it more difficult than it needs to be. Membership in CALA provides the means for us to continue to have a united voice when dealing with the regulators at the health department.

Thank you for your support.

Colorado Assisted Living Association.

For more information about QMAP please visit the State Health Department Website.

CALA does not manage the QMAP program.

https://www.colorado.gov/pacific/cdphe/medication-administrationqmap

 

Do you have any resources for Rating Residents Evacuation Capabilities for Assisted Living?

Answer:

Emergency Planning Resources for Assisted Living Residences

This information is from the website of the Colorado Department of Public Health and Environment. CDPHE

Rating Residents Evacuation Capabilities

As part of the Emergency Operations Plan (EOP), residents need to be rated on evacuation capabilities. CDPHE/HFEMSD Life Safety Code surveyors look to see if a facility has completed an evacuation worksheet on each resident, that helps facilities determine evacuation capability and risk factors for each resident. Surveyors look for this information even if local fire authorities have recommended that some facilities not attempt evacuation.

Ratings need to be current. If a resident’s condition changes, he/she should be re-evaluated promptly. The tools provided herein should make it easier to keep current ratings in the EOP.

The instructions and worksheet are from the National Fire Protection Association (NFPA), 101A, Guide on Alternative Approaches to Life Safety, 2004 Edition. NFPA codes, standards, recommended practices, and guides, of which the two documents herein are included, are developed through a consensus standards development process approved by the American National Standards Institute. CDPHE/HFEMSD produced this video in 2004 to help show facilities how to rate their residents.

Instructions:

  1. Make sure your computer has speakers to hear the video. (This video also was distributed to all Assisted Living Residences in 2004 in VHS format.)
  2. Read the NFPA Instructions for Rating Residents below.
  3. Print the Worksheet below, and make one copy for each resident you will be rating.
  4. Watch the video.
  5. Rate your residents and keep copies of the worksheets with your EOP, and with residents’ Care Plan information and Facesheets.
  6. Don’t forget to re-evaluate your residents as their conditions change.

 

Link to Instructions Here

 

Link to Worksheet Here

 

Link to Streaming Video Here

 

Link to Download Video Here

 

How much is the medicaid reimbursement for assisted living facilities in Colorado for room and board?

We are thinking about accepting medicaid for assisted living residents but I can’t find out how much the reimbursement is the facility each month.

Answers:

The answers is that it is not enough and not a fair amount compared to what Nursing Homes receive.

It is basically $2050 per month. There may be some variations depending on which county you are in.

This is one thing that CALA is working very hard hard. As of the time of this posting (April 2011) there has been a pilot program that was passed at the capitol to look into a tiered reimbursement program for assisted living.

This pilot program if carried out would show that the state could save money by moving people from the higher cost of Nursing Homes to Assisted Living Communities.

Others states are already doing this. California and many others.

We are working with our lobbyist and our legislative committee to get this pilot program up and running so that we can prove that increasing the reimbursement to Assisted Living will save the state money.

It will also mean that those in Assisted Living will be able to make more room for those with Medicaid because of the increased amount that would be paid.

This will help to make sure Seniors can actually receive better care and a higher level of dignity than many of them are receiving today because they are stuck in Nursing Homes when they don’t need to be.

If you want to be involved in our legislative committee please contact Chris Butler at vp@cala-co.org

CALA Board

You can also ask questions to our Lobbyist by visiting the Ask our Assisted Living Lobbyist Question Page

Paying overtime for assisted living communities in Colorado

Below is some information about the overtime rules for the State of Colorado. For a more detailed explanation please you can listen to a recorded session by visiting our Online Training Page.

First, a clarification re: the 8/80 exemption. The 8/80 regulations state that the employer must pay overtime to employees if they work more than 8 hours in a day (“daily overtime”) and 80 hours in a 14 day period (“80-hour overtime”). There was a question that was asked regarding whether you have to pay double overtime if both “daily overtime” and “80-hour overtime” accrued. The regulations allow an employer to take a credit for overtime paid when an employee works over 8 hours per day when determining whether overtime must be paid for hours over 80. The best way to explain this is through the use of examples and illustrations.

  1. Employee A works Monday through Friday, working five 9 hour shifts. The next week, the employee works Monday through Friday, working five 7 hour shifts. This totals 80 hours in the 14 day period. The employee is due 5 hours of overtime (because of the “daily overtime”).
  2. Employee B works Monday through Saturday, working six 8 hour shifts. The next week, the employee works Monday through Saturday, working six 8 hour shifts. This totals 96 hours in the 14 day period. The employer is obligated to pay 16 hours of overtime (because of “80-hour overtime”).
  3. Employee C works Monday through Saturday, working five 8 hour shifts, and one 9 hour shift. The employee works Monday through Thursday, working four 8 hour shifts. This totals 81 hours in the 14 day period. The employee is only due 1 hour of overtime. (Both “daily overtime” and “80-hour overtime” have accrued, but the payment of “daily overtime” is attributable towards the “80-hour overtime” under the regulations. This prevents paying double overtime.
  4. Employee D works Monday through Saturday, working six 9 hour shifts. The next week, the employee works Monday through Friday, working five 8 hour shifts. This totals 94 hours in the 14 day period. The employee is due 14 hours of overtime. (Again, both “daily overtime” and “80-hour overtime” have accrued, but the payment of “daily overtime is attributable towards the 80-hour overtime” under the regulations. Six hours of “daily overtime” accrued, and a total of 14 hours of “80-hour overtime” accrued. The employer is NOT required to pay 20 hours of overtime, only the 14 total hours since the payment of “daily overtime” is attributable to the “80-hour overtime.”)

Second, a clarification regarding Colorado rules relating to overtime. As noted in the presentation, an employer must pay for overtime if the employee works over 12 hours per day or shift, or 40 hours per week. A question was asked whether this applied where the employer takes advantage of the sleep time credit. The employer still must pay overtime for hours over 12 in a single shift, but may take a credit of up to 8 hours for sleep time if all the requirements are met.

Additional Resources

Finally, you asked for good websites for information. I would definitely suggest the United States Department of Labor Wage and Hour Division website (www.dol.gov/whd). The most helpful link would be the fact sheets (http://www.dol.gov/whd/fact-sheets-index.htm). Indeed, there is one fact sheet specifically for Nursing Care Facilities which may address some of the issues (http://www.dol.gov/whd/regs/compliance/whdfs31.pdf).

In addition, I would look to the Colorado Department of Labor website (http://www.colorado.gov/cs/Satellite/CDLE-Main/CDLE/1240336821467), and more specifically their Wage and Hour Division (http://www.colorado.gov/cs/Satellite/CDLE-LaborLaws/CDLE/1248095305236). This provides links and information on the Colorado Wage Act and the Colorado Minimum Wage Orders which provides information relating to minimum wage, overtime, and the like.

For a more detailed explanation please you can listen to a recorded session by visiting our Online Training Page.

Is there any state requirement for assisted living providers in Colorado for lunch to go?

If the residents go in the morning and will not be back to assisted living during lunch hour, do we have/require to provide lunch to go for the resident?

If the residents go in the morning and come back to assisted living pass the lunch hour, do we have/require to provide/serve lunch when the residents come back?

Answer:

The regulations state,

1.109 (3) Meals and Snacks

109 (3)(a) Meals

(i) At least three nutritionally balanced meals in adequate portions, using a variety of foods shall be made available, either directly or indirectly through the resident agreement, at regular times daily.

(ii) In the event the meal provided is unpalatable, a substitute shall be provided.

109 (3)(b) Snacks

(i) Between meal snacks of nourishing quality shall be available.

If a resident plans to be gone and requests a lunch to go, I would provide it for them. If they are gone and are late getting back at the designated meal time, I would provide an alternate meal (perhaps a sandwich). (i.e., I wouldn’t “hold” a lunch for them unless I knew they were coming back late and they had requested it).

It is a requirement that between meal snacks are available.

It is probably a good idea to address your “rules” in the house rules and the resident agreement.

CALA Board

I need an idea as how to write a policy/procedure for hiring someone with a drug related offence in assisted living in Colorado

Regulation requiring how an employee with prior drug related conviction will be monitored

Answer:

I’m not sure why, but I couldn’t find this conversation on the website. Maybe I’m just too late. I’m no attorney, but here are my thoughts…

  1. a) Writing your P&P means you better stick with the decisions you make. I like to put a lot of “discrepancies will be investigated by E.D. and E.D. will make all final decisions”, that way I’ve got a little wiggle room, rather than saying they will or won’t be hired based on the policy
  2. b) You can’t really take into account more than a 7 year look back
  3. c) If there are minor offenses and you’re considering a hire, you can ask the employee to provide court records for your investigation
  4. d) Don’t recall any specific regs, but they generally say that “a policy must be in place” and you are obligated to keep the residents safe

Ultimately, it’s our obligation to operate safe communities for residents. Drug related offenses, unless extremely minor are usually reason enough for me to forfeit that applicant and move on to someone else.

Jeremy R. Klassen

CALA Board Member

How can we keep the state from reducing assisted living medicaid rates in Colorado?

UPDATE!

As of July 2013 CALA has worked with the state legislature to restore the previous decreases back to their original amounts. Thank you to everyone on the legislative committee for your efforts.

How can we keep the State from reducing Assisted Living Medicaid rates in Colorado?

Medicaid rates for assisted living have decreased substantially and new regulations/requirements have increased in the past few years. Providing care for these clients is becoming more and more difficult.

How do we show the State how much money we are saving Medicaid by taking care of these clients rather than them going into nursing homes?

How do we hold our representatives responsible for making “common sense” decisions about Medicaid reimbursement rates?

Transportation receives more for a 1 one-way trip to the Dr’s office than assisted living receives for 24 hours of care which includes meals, medication management, and many other services

Answer:

I asked Tim Cortez from the Medicaid office about future decreases. He said that there were no more planned cuts to assisted living. CALA’s Legislative Committee actively addresses these issues. We are in a planning phase with our lobbyist. You can have first hand knowledge of our progress by joining the Legislative Committee and helping us out. Please Email me at vp@cala-co.org

Chris Butler

CALA VP and Legislative Committee Chairperson

Join CALA

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