Personal Care Boarding Homes Chapter VII, §1.1 et seq.
Colorado licenses assisted living under personal care boarding home rules. Rules were revised in 1993. The number of licensed facilities has risen from 238 in 1990 to 385 in 1995 and 469 in 1998. Nursing home beds occupied by Medicaid recipients have remained stable over the past 10 years at 10,400. State respondents attributed the stable census to the expansion of home and community based programs, including reimbursement of personal care boarding homes. In 1995, the legislature revised the Medicaid rate for alternative care facilities (personal care boarding homes) and participation rose from 70 facilities to 179 by March 1998. The number of HCBS waiver participants in ACFs rose from 600 to 960 by June 1996 and 1,400 by March 1998.
While the regulations allow double occupancy and shared bathrooms, the majority of new construction provide private rooms or apartments, including homes that contract with the state to serve Medicaid recipients. The supply of personal care boarding homes is expected to increase. The licensing agency notes that many nursing facility owners are developing their own personal care boarding homes and few nursing home operators have complained about the level of care offered.
Personal care boarding home is "a residential facility that makes available to three or more adults not related to the owner of such facility, either directly or indirectly through a provider agreement, room and board and personal services, protective oversight, and social care due to impaired capacity to live independently, but not to the extent that regular 24-hourmedical or nursing care is required."
The rules allow no more than two people to share a room for facilities built after July 1, 1986. Single occupancy rooms must have at least 100 square feet and double occupancy rooms at least 60 square feet per person. Cooking is not allowed in bedrooms and facilities must provide access to a food preparation area for heating or reheating food or making hot beverages subject to "house rules." Cooking may be allowed in facilities which provide apartments rather than bedrooms. Facilities must provide at least one bathroom for every six residents.
Personal care boarding homes may not admit or retain residents who are:
Consistently, uncontrollably incontinent of bladder unless the resident or staff is able to prevent it from becoming a health hazard;
Incontinent of bowel unless they are capable of self-care;
Require 24-hour nursing or medical service;
Need restraints; or
Have a communicable disease.
Each facility develops their own admission criteria based on the capacity of the facility. A review of Medicaid pre-admission screening assessment forms showed that Medicaid waiver participants in ACFs had fewer skilled needs than nursing home residents.
Facilities must provide a physically safe and sanitary environment, room and board, personal services (transportation, assistance with activities of daily living and instrumental activities of daily living, individualized social supervision), protective oversight and social care. Written "board and care plans," which must be reviewed at least annually, are required for each resident and include a list of current prescribed medications (dosage, time and route of administration, whether self-administered or assisted), dietary restrictions, allergies and any physical or mental limitations or activity restrictions.
Nursing and therapies may be received if provided by a home health agency.
Medicaid rules limit room and board charges for Medicaid recipients to $448 a month. Effective July 1998, the Medicaid rate for services is $29.88 a day. The rate covers oversight, personal care, homemaker, chore and laundry services. The state is interested in developing tiered rates.
Room and board
Most larger facilities have hired LPNs to administer or manage medications and ensure that physician's order have been received and recorded. Unlicensed staff may assist with self-administration but they cannot take physicians' orders over the phone.
Facilities must employ sufficient staff to ensure provision of services necessary to meet resident needs.
Administrators must meet the minimum education, training and experience requirements by successfully completing a program approved by the department. Acceptable programs may be conducted by an accredited college, university or vocational school, or a program, seminar or in-service training program sponsored by an organization, association, corporation, group or agency with specific expertise in that area. The curriculum includes at least 30 actual clock hours of which at least 15 are comprised of a discussion of each of the following topics: resident rights; environment and fire safety, including emergency procedures and first aid; assessment skills; identifying and dealing with difficult behaviors, and nutrition.
The remaining 15 hours shall provide emphasis on meeting the personal, social and emotional care needs of the resident population served.
Staff All staff, including volunteers, must be given on the job training or have related experience in the job assigned to them and shall be supervised until they have completed on the job training appropriate to their duties and responsibilities or had previous related experience evaluated. Training and orientation in emergency procedures shall be provided to each new staff member, including volunteers, within three days of employment.
Staff members not serving as an operator who have direct responsibility for the provision of personal care, i.e. hygiene, of residents or for the supervision or training of residents in the resident's own personal care, shall provide documentation of either successful completion of course work in the provision of personal care or previous and related job experience in providing personal care to residents.
The facility shall provide adequate training and supervision for staff comprised of a discussion of each of the following topics: resident rights, environment and fire safety, including emergency procedures and first aid; assessment skills; and identifying and dealing with difficult situations and behaviors.
The owner or licensee may have access to and shall obtain any criminal history record information from a criminal agency for all persons responsible for the care and welfare of residents.
The regulations require that facilities provide access to the ombudsman program to the facility and residents at reasonable times.