Colorado offers regulated and licensed assisted living facilities in a variety of settings. Assisted living is available in cities, small towns, and mountain communities. Colorado has a growing population of older adults and beautiful outdoor spaces. The state is popular as it has a higher cost of living than many surrounding states.

Assisted Living Facility (ALF) Requirements

The Colorado Department of Public Health and Environment licenses assisted living facilities in the state. Adult foster homes and residential treatment facilities for persons with mental illness are also licensed under the rules governing assisted living communities. Residents who may not be safe outside of the facility where they reside must be in a secure environment. Any facility certified to receive reimbursement from Medicaid must meet additional requirements and be called an alternative care facility.

Assisted Living Description

An assisted living residence is a residential facility designed for three or more adults unrelated to the owner. The facility provides room and board, personal services, protective oversight and social care necessary due to an inability to live independently. The facility must provide 24-hour supervision, although 24-hour medical or nursing care is not required.

Under the rules governing assisted living, the residential treatment facility for individuals with a mental illness is not licensed to support more than 16 individuals unrelated to the licensee. The residents must receive treatment based on their psychiatric needs.

Assisted Living Admission, Retention and Agreements

The resident and facility agreement must be provided upon move-in. The agreement outlines the financial arrangement, including charges, refund and deposit policies, the services included, and optional services that require an additional charge. The agreement will also outline the services that are provided by the facility as well as those that are not provided by the facility and those services that the facility will help residents in obtaining. Some of the additional services include but are not limited to transportation services, the availability of therapeutic diets, and whether the facility will provide beds, linens, furnishings, and any supplies that the resident may require.

Assisted living facilities are not permitted to admit individuals requiring 24-hour nursing or medical service, require restraints, have a communicable disease, have a substance abuse issue, are bedridden (with limited or no chance for improvement), or are uncontrollably incontinent.

Should a long-term resident become bedridden, there are some situations where they could be permitted to stay at the facility. If a physician can describe services required to support the resident’s health needs, if the facility ensures that they are met, and if there is adequately trained staff to meet these needs, then the resident could be allowed to stay.

All assisted living facilities must provide a physically safe and sanitary environment and protective oversight for their residents. Based on the residents’ interests, they must provide personal services (assistance with ADLs) and social and recreational activities within and outside the facility.

Each resident must have a written care plan reviewed at least annually. The care plan must assess the individual’s physical, health, behavioral, and social needs and preferences and consider their self-care ability. The plan must include whether the resident can administer their medications if there are dietary restrictions and any mental or activity limitations and restrictions.

Assisted Living Food and Medication Services Requirements

Each community must provide the resident with three nutritious, balanced meals and between-meal snacks. If a resident is prescribed a therapeutic diet by a physician, meals may be provided.  Residents are encouraged to participate in meal planning and making menu suggestions, and facilities must reasonably accommodate these suggestions.

Assisted living staff may assist with medications on an as-needed basis with some conditions.  The residents must be capable of requesting medication, and there are documented instructions for using the medication. A QMAP (Qualified Medication Administration Person) is an employee of the facility who has passed an approved medication training course given by a licensed nurse, physician, physician’s assistant, or pharmacist. The person must pass a competency test for assisting with medication. The QMAP may administer prescribed, and non-prescribed medications but is not permitted to draw or administer medication in a syringe for injection into the bloodstream or skin, including insulin pen devices. The QMAP must complete a competency evaluation every five years.

Assisted Living Staffing and Training Requirements

Every facility must have a full-time administrator and sufficient staff to care for its residents.  A QMAP and at least one staff member with current certification in adult first-aid must always be on-site.

No minimum staff ratios are required, but the facility must have a method for determining adequate staffing levels. This includes determining if the facility has awake staff 24 hours a day.  The facility must have sufficient staff to provide necessary care for the residents of the facility.

Administrators must complete a 30-hour training program, with 15 hours of the training covering residents’ rights, environment and fire safety, emergency procedures, first aid, nutrition, and the ability to assess, identify, and address difficult situations and behaviors. The remaining 15 hours of training cover the resident population’s personal, social, and emotional needs. This training includes medication management, oxygen use, chronic illnesses, legal and ethical issues, care and activity planning, end-of-life care, and the use of community resources.

All staff must either have related job experience or be provided on-the-job training for any job assigned to them. Within one month of being hired, the facility must provide adequate training on assessment skills, infection control, identifying and dealing with difficult situations and behaviors, and health emergency response.

Owners and administrators must undergo a fingerprint background check. Owners are responsible for obtaining a criminal background check of administrators, staff, and volunteers.

Assisted Living Housing Requirements

The state does not require apartment-style units. At most, two people can share a room in any facility built after July 1, 1986. Cooking may be available in facilities that provide apartments.  Cooking is not permitted in bedroom-style units, but all facilities must provide access to a food preparation area for heating or reheating food and making hot beverages. One full bathroom is required for every six residents.

What Is Included With Assisted Living Care In Colorado?

The services provided in assisted living communities generally fall under three broad categories: personal care, medical care, and amenities. 

Most people move to assisted living communities because they’re looking for convenient access to personal care. These services assist with activities of daily living, such as bathing, dressing, walking, and toileting. Communities also provide supervision and can deliver care for unforeseen needs or in cases of emergencies.

Health Care Services

In Colorado, AFLs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 59% of communities providing skilled nursing. Many have health care specialists and on-site services, with 56% of communities offering dental care. In addition, some facilities provide hospice services. 

ALFs may provide specialized care for people diagnosed with Alzheimer’s disease or other forms of dementia. These special care units have additional security measures to ensure residents don’t wander, which can be a symptom of Alzheimer’s disease. Typically, they also offer programs designed to improve cognitive function and routines that help lower stress.

Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Colorado, 81% of communities conduct depression screenings, and 52% offer mental health counseling. Social work programs are also found in 52% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents have access to all the necessary resources.

Activities of Daily Living (ADLs) Assistance Services

A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglecting household chores. 

Residents in Colorado assisted living facilities often receive help with their ADLs. In Colorado, 18% of residents need help with eating. Other commonly used services include bed transfer (21%), toileting (34%), and walking (51%). Caregivers in ALFs help 40% of residents dress and 54% of residents bathe.

Cost Of Assisted Living Care In Colorado

The average cost of assisted living care in Colorado is $4,750. This is $250 higher than the monthly national average of $4,500. The cost of living in Colorado is more than the national average by 5.3%, with health care costs less than the national average by 2.1% and housing costs more than the national average by 16.4%.

The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,800 in the Pueblo area to a high of $6,275 per month in the Boulder area of Colorado.

How Costs Compare In Nearby States

Living close to one of Colorado’s borders may make assisted living in a neighboring state an affordable option. Seniors in most bordering states pay less than the average senior in Colorado. Seniors in Utah pay around $3,500 per month, while costs in Kansas average $4,580 and New Mexico average $4,498.

How to Pay for Assisted Living

Colorado Assisted Living Oversight

The Colorado Department of Public Health and Environment (CDPHE) oversees all ALFs in the state. CDPHE accepts complaints from residents or anyone concerned about an ALF, including anonymous complaints. Complaints may involve concerns about

• Quality of care.
• Rights of residents.
• Building or equipment safety.

Records of citations are public. Complaints are prioritized and investigated based on the type of allegations and risk of harm to residents. If an ALF is found to be in violation, a citation will be issued, and the violation must be corrected. 

Legal Resources for Seniors in Colorado

Older adults are increasingly the targets of scams and fraud. Attorneys who practice elder law help older adults understand and protect their legal rights. 

Colorado’s Legal Assistance Program helps older adults understand their legal rights and access the justice system. Individuals can access the program by contacting their local Area Agency on Aging office. Those with low income can seek assistance through Colorado Legal Services. Private law firms throughout the state can assist with elder law concerns and estate planning.

Older adults and their loved ones with concerns about elder abuse or other serious problems within an assisted living facility should contact their local Department of Human Services office or Adult Protective Services. 

Quality and Safety of Assisted Living Facilities in Colorado

ALFs must be licensed to operate within the state of Colorado. The Colorado Department of Public Health and Environment (CDPHE) licenses and monitors all ALFs operating within the state. CDPHE accepts complaints from residents, their families, and other concerned members of the public. The department investigates complaints and issues citations and other penalties for violations. CDPHE also provides a public database on facilities, including recent violations, which can be a helpful tool for people in the process of choosing an ALF. 

Colorado has detailed regulations that help ensure high-quality ALFs within the state. For example, regulations require up to two residents to share a bedroom in newer facilities, and a full bathroom is required for every six residents. Facility administrators must complete a training program on resident care and psychosocial needs.