Colorado nursing homes are seeing higher citations and resident complaints as state regulators weigh changes to minimum staffing standards for nursing homes.
The number of formal complaints from SNF residents in Colorado continued to climb, reaching 7,426 during the 2025 fiscal year across the state’s nursing homes and assisted living communities, a story in the Denver Post states.
And, data from the Centers for Medicare and Medicaid Services (CMS) show that 40% of Colorado nursing homes had severe deficiencies in 2025, up from 14% in 2019, giving the state the fifth-highest rate of serious violations in the nation.
The Colorado Department of Public Health and Environment reported 175 active investigations in June, including 89 involving nursing homes. Regulators have issued citations related to abuse and neglect, infection control, and accident hazards.
State health department citations led to at least 317 fines for violations since 2023, with Colorado holding money from the fines collected each year in a nursing home penalties account, which this year had a balance of nearly $20 million, the story notes.
“Fines are an outdated compliance tool,” Doug Farmer, president of the Colorado Health Care Association (CHCA), told the Denver Post. “I don’t see the rationale in citing a care center for inadequate staff and then taking money from them as a punishment. If they need more staff or to increase staff training, taking money from them is contrary to that goal.”
Providers in the state attribute workforce challenges to persistent labor shortages and financial pressures.
Nursing homes face a 47% annual staff turnover rate and operate on margins of roughly 2%, making it difficult to recruit and retain nurses, according to CHCA, which represents the for-profit long-term care companies.
Low profit margins constrain companies from paying higher wages, and it’s difficult to compete with other parts of the healthcare system for nurses, Farmer said.
Those pressures are expected to intensify as Colorado reduces Medicaid reimbursement rates by 2% beginning July 1. The cut lowers the state’s average Medicaid payment from about $288 per resident per day, an issue providers say will further constrain wages, staffing levels, and admissions.
At the same time, Colorado is engaged in a formal rulemaking process to revisit its state minimum staffing standards. Current regulations require at least two hours of nursing care per resident per day, but regulators are considering increasing the minimum to three hours. Industry groups oppose the change, arguing the state should avoid imposing standards providers cannot afford, while resident advocates contend the current minimum contributes to chronic understaffing and poor outcomes.
State officials expect to make a decision on the revised staffing standard in February. The discussions on staffing reform are focused on whether the current two-hour minimum remains appropriate given resident needs and the financial realities facing providers.
The debate comes as the state’s long-term care system contracts. Since January 2023, Colorado has lost 10 nursing homes.
Four states ranked above Colorado in nursing home deficiency rates: Illinois at 61%, South Dakota at 53%, and Delaware and Rhode Island at 45% each.
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