Service Delivery

Goal 3: Create a Person-Centered Delivery Model for Long-Term Services and Supports

The majority of older Coloradans want to age in community. In order to support this desire, Colorado can support older adults through various long-term services and supports. These include:

• Assistance with housekeeping;
• Bathing and dressing;
• Transportation;
• Food preparation and nutrition; and
• Other activities of daily living

Long-term services and supports may also include facility-based care such as assisted living facilities or skilled nursing facilities.

The State of Colorado provides or supports long-term services and supports through many state agencies, including:

• Colorado Department of Human Services (CDHS): CDHS deploys Older Americans Act funding and State funding for senior services through the State Unit on Aging to 16 regional Area Agencies on Aging. CDHS also administers the Home Care Allowance program to provide cash assistance to cover home-care providers. Additionally, the Adult Protective Services (APS) program and CAPS Check Unit help ensure older adults are protected from abuse and neglect and reduce self-neglect. 
• Colorado Department of Health Care Policy and Financing (HCPF): HCPF deploys Home and Community Based Services (HCBS) waivers through Health First Colorado (the state's Medicaid program). HCPF also convenes the Direct Care Workforce Collaborative to support the agencies and staff providing care to older adults.
• Colorado Department of Transportation (CDOT): CDOT provides transportation services to older adults and Coloradans with disabilities with 5310 Funds.
• Colorado Department of Public Health and Environment (CDPHE): CDPHE oversees the licensing and credentialing of long-term care agencies.
• Colorado Department of Labor and Employment (CDLE): CDLE's Division of Labor Standards and Statistics provides support and resources for direct-care workers, including the Direct Care Workforce Stabilization Board recommendations.

The U.S. Department of Health and Human Services estimates that 70 percent of adults over the age of 65 will need some form of paid long-term services and supports. In order to address these needs, the state of Colorado is working toward the following goals.

Long-Term Services and Support Efficiency

Our goal is to provide more Coloradans with the long-term services and supports in the most effective and economical methods possible. In order to accomplish this goal, Colorado is in need of significant systems change to most adequately provide resources for older Coloradans in need. This systems change will include:

• Data Collection strategy refinement;
• Alternative funding models; and
• Trust building amongst skeptical older adults

Though most older adults want to age in their community, facility based care may be the most appropriate option for some older Coloradans. Colorado strives to reduce the stigma associated with facility-based care and reduce the cost burden to Colorado families by improving safety and quality of care.

Colorado has consistently been a national leader for state funding for older adult services. With older adult population increases, the Multi-Sector Plan on Aging recommends exploration of innovative older-adult funding streams to keep pace with the growing population. We will identify the most efficient and effective funding strategies to ensure older Coloradans have access to necessary supports. This includes federal advocacy, philanthropic engagement, business community participation and analysis of our state funding levers. Our goal is to provide the most effective resources to more older Coloradans.

Direct-Care Workforce Support

The direct-care workforce is the backbone of the long-term services and supports industry. Direct-care workers include:

• Personal care aides; 
• Certified nursing assistants;
• Home health aides;
• Companions;
• Job coaches;
• And others

Colorado is facing a significant direct-care workforce shortage. In order to provide the necessary long-term services and supports to older Coloradans, the State must prioritize sustaining the direct-care workforce. Supports may include but are not limited to: 

• Paying adequate wages;
• Providing necessary training and education resources; and
• Prioritizing professional development opportunities

By stabilizing the direct-care workforce, Colorado can increase service capacity to provide long-term services and supports to older Coloradans in more equitable ways.

Caregiving

Rosalynn Carter famously said, “There are only four kinds of people in the world — those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.” Carter recognized the universal connection to caregiving and Colorado recognizes the 600,000 family caregivers who provide 560 million hours of unpaid care annually. Colorado will align strategies with the National Strategy to Support Family Caregivers framework to further develop respite services, behavioral health care support, training resources and payment models. This will provide a blueprint to support the unpaid caregiving cohort in Colorado.

Older Coloradans often serve as care providers. More than half of Colorado families rely on Family, Friend and Neighbor (FFN) resources for childcare and many of those providers are grandparents. Older adults often serve as kinship caregivers to grandchildren or other relatives.