After a year in a Colorado nursing home, George McNeill, 79, said he’s OK. He eats three meals a day, has a good roommate, rests easily knowing laundry and cleaning will get done, and gets the help he needs.
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McNeill grew up in New York City and loved his career directing legislation and local elections for the National Rifle Association. He’s been in and out of seven nursing homes in nine years, due to a condition that causes him to collapse into unconsciousness, and ranks his current stay at Durango Health and Rehabilitation as one of the best.
Once, after he pressed his call button, nobody arrived for 21 minutes, McNeill said, but nurses typically arrive in under 10 minutes.
“These places all have the same toys. They have wheelchairs. They have oxygen. They have beds that go up and down to make it easy to get in and out. It’s the staff that makes the difference,” he said. “If I collapse here, there’s somebody who can take care of me. I feel safe.”
But the conditions in nursing homes and assisted living centers around Colorado, where residents often receive as little as two hours of direct care each day, are deteriorating. Chronic understaffing has led to severe deficiencies at these facilities, more than in most states, with rising numbers of complaints lodged by residents.
In 2025, 40% of nursing homes in Colorado had severe deficiencies, defined as problems that can threaten residents’ lives, according to Centers for Medicare and Medicaid Services data. The state’s number went up from 14% in 2019.
The only states with higher nursing home deficiency rates were Illinois (61%), South Dakota (53%), Delaware (45%) and Rhode Island (45%).
Meanwhile, the rules governing care, such as the federal requirement that nursing homes keep a registered nurse on-site 24/7, have been relaxed. Long-term care industry leaders say caregivers with the necessary skills cannot be retained for the wages companies are willing to pay. This is happening as a demographic shift to an older, grayer population slams Colorado.
The estimated 38,069 residents in Colorado’s 210 nursing homes and 675 assisted living centers are filing formal complaints at the rate of 20 a day, and the annual total hit 7,426 in the 2025 fiscal year, up from 6,778 in 2024 and 6,342 in 2023, Colorado Department of Human Services records show.
That equates to a complaint for about one in five residents of these facilities.
‘Residents are suffering’
The complaints include “disturbing numbers” alleging “abuse and neglect,” said Leah McMahon, director of Colorado’s Long-Term Care Ombudsman program, which deploys 64 trained inspectors to investigate and try to solve problems affecting residents.
Being in a nursing home no longer guarantees frequent daily contact with licensed nurses, and conditions often lead to “loss and grief, no joy, no animation, no engagement in life, and complete loss of hope that somebody is going to help residents feel better, take their pain away,” McMahon said. “Their dignity is lost. Their respect is lost. It’s like being the number on the wall outside the door of your room. It’s not like being a person. Residents are suffering.”
The Colorado Department of Public Health and the Environment, which licenses nursing homes and assisted living facilities, reported 175 investigations in progress in June, including 89 in nursing homes and 86 at assisted living facilities. Since 2023, state regulators have issued 6,928 citations, including 140 for abuse and neglect by staff, 254 for accident hazards, and 257 for failing to control infections, according to state records.
Among inspectors’ findings:
- An insufficient staffing citation issued to a Lakewood nursing home in 2025 alleged that nurse aides “failed to ensure residents received their showers as scheduled and incontinence care in a timely manner,” and complained to residents about being short-staffed. An employee told a state inspector that two nurse aides were assigned to 50 residents, the report said.
- At a Pueblo nursing home in 2024, a state inspector heard from a man who waited more than 30 minutes for assistance getting to a bathroom and “reported extreme pain and discomfort and was afraid to leave his room due to fear of falling again.”
- This year, a man in a Longmont nursing home cited for insufficient staffing told an inspector that “he had pushed his call light button before because he was having a hard time breathing and had to wait over an hour.”
- At a nursing home in Craig, a state inspector in 2024 noted that “some of the residents have resorted to checking on one another when they have noticed call lights were on.”
- For a citation issued to a Glenwood Springs nursing home in 2025, a state inspector wrote that a resident “said he sometimes called for assistance before he actually needed it because he knew he would have to wait for a long time.”
A U.S. Department of Health and Human Services of elder care in Colorado, based on unannounced visits at 20 facilities in 2022, concluded that inadequate oversight by state regulators and nursing home managers, along with high staffing turnover, led to 556 deficiencies. Those included 165 deficiencies related to life safety requirements, 210 related to emergency preparedness and 181 related to infection control.
Seniors and families turn to assisted living and nursing facilities to ensure needs are met and count on the caregivers. Pushing a call button to summon help often is done reluctantly, according to state ombudsmen.
And when nobody responds, “you feel helpless,” said Sherrie Jarrett, 79, recalling her experience in a Parker assisted living center where she and her late husband lived.
The center initially offered “mystery trips,” frozen yogurt gatherings and pottery to combat isolation. But then Jarrett fell, breaking her hip. Staffing decreased.
“We didn’t have an activities director for almost five years” and “at the tail end it was depressing,” she said. Jarrett moved to a nursing home where the staffing is sufficient to ensure swift responses, she said. “That’s who your day-to-day contact is with, the staff.”
Around Colorado, state health department citations have led to at least 317 fines for violations since 2023, the earliest date in recent federal records. The average nursing home fine in 2025 was $20,563, and assisted living center fines average around $2,000, according to industry records. Colorado holds money from the fines collected each year in a nursing home penalties account, which this year had a balance of nearly $20 million.
The administrators of facilities — 83% of them for-profit, up from 76% a decade ago, a higher proportion than in most other states — must pay fines from their operating budgets.
“Low profit margins” constrain companies from paying higher wages, and “it’s difficult to compete with other parts of the healthcare system for nurses,” said Doug Farmer, president of the Colorado Health Care Association, which represents the for-profit long-term care companies.
“Fines are an outdated compliance tool,” Farmer said. “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.”
Industry blames nurse shortage
Long-term care industry leaders blame workforce challenges, saying companies are hard-pressed to recruit and retain enough certified caregivers.
The annual turnover rate in Colorado facilities is 47%, and nursing home companies’ annual profits average around 2%, said Jenny Albertson, the Colorado Health Care Association’s director of quality and regulatory affairs, who previously ran nursing homes for 16 years.
Cuts in Medicaid funding will exacerbate pressures, reducing the $288 daily per-resident rate paid to facilities in Colorado by 2% starting July 1.
Colorado’s overall nursing shortage has intensified, with the federal Health Resources and Services Administration projecting the state will be short 7,100 licensed practical nurses and 6,090 registered nurses by 2034.
Running a nursing home with nearly one in two nurses leaving each year “is a struggle,” Albertson said. “You lose that brain trust that knows what it means to give patient-centered care. It brings chaos. It sucks away resources from the actual act of caregiving,” she said.
“We’re seeing workforce pressures reaching a critical mass,” she said. “Nursing homes have to right-size to the care they can provide by closing their doors to new admissions. We’re seeing a need to cap the care we can provide in order to do it well.”
Meanwhile, state ombudsmen blame commercial profit priorities and low wages — nurse aides typically earn less than $20 a hour — that force many facility caregivers to work second jobs, even after heavy 12-hour shifts. The ombudsmen point to impossible care burdens that cause burnout, irregular schedules, lack of training and the difficulty of taking care of seniors who, in previous decades, would have qualified for hospital care.
“When we’re looking at private-equity-owned facilities, we see a systemwide stripping down of the quality of life. The food goes down. The care goes down. Staff leaves. It’s a revolving door,” McMahon said. “…The bottom line is the dollar, not people care.”
Two hours of care per day
A Colorado rule requires companies to ensure at least two hours of nursing care per resident per day. This year, state officials and the industry are debating whether to keep that minimum standard.
At the federal level, Trump administration officials on Dec. 2 repealed a proposed 3.48 hours-of-care requirement, replacing it with a looser standard that “sufficient” care is acceptable. On Dec. 3, Trump officials also repealed a federal rule requiring 24/7 on-site registered nursing service.
Colorado still has a state-level registered nurse requirement on the books, but since 2021, health overseers have been waiving that requirement at all nursing homes if a registered nurse is on call, a licensed practical nurse is present and medications are carefully managed.
State health officials don’t know how many nursing homes keep a registered nurse on-site 24/7, Department of Public Health and Environment spokeswoman Alexandrea Kallin said.
Colorado regulators who recently began a formal rulemaking process had suggested a state-level minimum of three hours of nursing care per resident. The Colorado Health Care Association objected, favoring alignment with the Trump administration.
“We have allegations of people literally not being seen for days,” said Shannon Gimbel, manager of the ombudsman investigations across an eight-county metro Denver area. “Understaffing is significant in any complaint we get. It is usually the underlying cause, and if companies are only required to provide two hours of care, that’s what they are going to provide.”
Gimbel worked in nursing homes for two decades and is participating in the rulemaking discussions.
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“The industry will scream that facilities are not going to be able to afford to stay open. Elder-care advocates will argue that the burdens on staff are too great and that companies should pay better wages and provide a better work-life balance… The system is failing, and the staffing in the facilities is dismal,” she said.
Colorado’s aging population
The demand for elder care in nursing and assisted living facilities is projected to increase as Colorado’s population ages.
While the state’s average age of 38 remains slightly younger than the national average, residents who are over 60 now outnumber those under 18 for the first time in state history. The population most likely to use nursing and assisted living facilities, those who are 75 and over, is the fastest-growing segment, according to the Colorado Department of Local Affairs.
The number of Colorado residents over 80, estimated by state demographers at 201,806, is projected to increase by 75% and reach 353,452 before 2034. That would be 5.4% of the state’s population, or one in 20 residents.
More will need care in facilities, requiring 59,340 registered nurses and 12,970 licensed practical nurses by 2034, according to industry projections. Colorado nursing and assisted living facilities hold a total of about 46,000 beds, with a nursing home occupancy rate around 80%, according to industry data.
By 2034, industry officials estimated Colorado would need 50 additional nursing homes and 40 more assisted living centers.
While growing numbers of older people rely on in-home care, it becomes more costly than care in facilities when they need 24/7 attention, said Deborah Lively, chief executive for LeadingAge, which represents non-profit facilities.
The workforce challenges have intensified as corporate owners of nursing homes and assisted living facilities focus on “trying to do more with less,” Lively said.
“It’s scary to think about it. There are all these aging people, and there are not enough workers to take care of them,” she said. “I don’t know how it is going to be addressed.”
State enforcement
Officials at the Colorado Department of Public Health and Environment say they are enforcing state and federal rules aggressively.
However, the federal rule that previously required 24/7 onsite registered nurse service, reduced by Trump officials effective Feb. 2, now only requires that a nurse be “on duty or present for at least eight consecutive hours each day.”
Colorado’s rules still say facilities must keep a registered nurse on-site 24/7, but under the waiver, facilities get by with a registered nurse or physician on-call, a licensed practical nurse present and a clear policy for managing medications
“We are concerned anytime a facility’s systems break down in ways that put residents at risk. Residents rely on facilities to provide safe, appropriate care, and CDPHE’s oversight is focused on ensuring facilities meet those responsibilities,” said Elaine McManis, the state health department’s director of health facilities and emergency medical services. “Our concern increases when problems are repeated, systemic, or not corrected.”
State health officials will decide in February about a state-level standard for hours of care per resident, said Dr. Ned Calonge, Colorado’s chief medical officer. State rules require “the level of care and service that each resident needs, regardless of the hours set in the minimum standard,” Calonge said.
“We’re having discussions with stakeholders about the standards we want to see for the industry. Is two hours enough? Or three hours? Have we set the floor at the right level? That’s what we’re talking about,” he said. “On the side of the patients and their families, they want more contact with licensed professional nurses. And from the industry side, it is: ‘What cost does that translate to?’ ”
Since January 2023, 10 nursing homes in Colorado have shut down, a loss of 418 beds, along with 66 assisted living facilities, where 1,391 more beds were lost, according to the state. Health officials declined to identify the facilities or to specify reasons, other than saying that the long-term care industry opens facilities and increases or decreases beds based on business factors.
This year, one nursing home reported failing to meet the two-hour care standard, and 10 facilities didn’t provide data. State officials also declined to identify those facilities.
“CDPHE’s goal is not to close facilities. Our goal is safe resident care. We use a range of tools depending on the severity of the issue, including directed plans of correction, temporary management, conditional licenses, denial of license renewal, revocations, and closure when necessary,” McManis said.
‘This is my home now’
Inside the Life Care Center of Littleton, southwest of Denver, administrator Sara Dent last month had beds for 115 residents, along with an additional 35 seniors sent by hospitals to the facility for short-term rehabilitation.
The center’s nurse and support staff numbered 195, and Dent said residents receive 3.97 hours a day of nurse care. The facility is one of more than 200 in 27 states run by Tennessee-based Life Care Centers of America.
Dent knows the residents by name. She knows the caregivers, including a 75-year-old Spanish-speaking dishwasher who said she hoped to retire and become a resident of the facility where she’s worked for two decades.
Most staffers work second jobs to make ends meet, Dent said. She pays the nurse aides $19.29 an hour, the minimum wage in Denver, more than the state-required $15.16 that applies in Littleton.
Dent works to instill a culture of swift response anytime a light outside a room door flashes on. “Our patients have to come first,” she said.
Residents said they were mostly comfortable and pleased with the facility.
“I miss my yard at home. I miss my dog,” said William Reitz, 94, a retired engineer, sitting in a wheelchair by his bed, across from a framed photo of his departed spouse.
“I think I still have it mentally,” Reitz said. He discussed with Dent the plan to upgrade his wheelchair to a motorized version so that he could roll around the building and grounds independently, as long as his insurance would cover the cost.
“Then I won’t be pestering people to push me,” he said, noting he’d still be attending daily exercise sessions. “I’ll be able to do it on my own… This is my home now.”
For artist Terry Dunlap, 81, the main priority is “to be able to paint,” following head injuries in 2025 that necessitated a move from her family home in Conifer. She sat surrounded by scores of her abstract paintings, a Cat Stevens song playing as she worked in a two-room suite she’s converted to a studio.
“I wish there were more staff here at night. I’d like to walk. You have to have a CNA (certified nursing assistant) with you. So I get a bit frustrated,” Dunlap said, though she assessed the overall conditions positively. “Just a couple more” staffers would help, she said.
Like other nursing home administrators, Dent said she regularly sees state health inspectors. Each time they arrive at the facility, “they are hunting” for any deficiency, such as a rug positioned by the front entrance that could be deemed a tripping hazard, she said.
Some residents are reluctant to file complaints with state ombudsmen, fearing retaliation or even involuntary discharge, said Jayla Sanchez-Warren, director of the Denver Regional Council of Governments’ Area Agency on Aging.
Earlier this year, Sanchez-Warren visited a relative in her 80s with dementia inside a facility.
“She was hungry. She did not know when she last had a shower,” Sanchez-Warren said, adding that she couldn’t find anybody on the facility’s staff with the authority to help.
She asked her relative whether she wanted her to press a complaint.
“She said, ‘No, don’t you make it harder for me,’ ” Sanchez-Warren said. “She was fearing retaliation. Once you leave, they are still there. They have to deal with it if you cause problems. She was adamant. ‘Don’t you cause me problems.’ ”
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