Memory Care in Colorado

Table of Contents

Memory Care in Colorado

Table of Contents

• The Cost of Memory Care in Colorado
• Colorado Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Colorado?
• More Ways To Pay for Memory Care in Colorado
• Memory Care Laws and Regulations in Colorado
• Free and Low-Cost Resources for Seniors in Colorado
• Colorado COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

We added 25% to the assisted living rates listed in Genworth Financial's 2021 Cost of Care Survey to come up with an estimated cost for memory care in Colorado ($5,938). This is the highest average in the region and about $300 more than the national median of $5,625. Costs in Kansas ($5,725) and New Mexico ($5,623) are closer to the U.S. average. Rates are lower in Wyoming ($5,211) and Nebraska ($5,095), while Utah has the least expensive care with an average cost of $4,375.

Memory care costs in Colorado range from $4,750 in Pueblo to $7,844 in Boulder. In Grand Junction, which is in the western area of the state, costs are relatively affordable at $5,313. In the capital, Denver, seniors pay an average of $6,875 for memory care, making it the second most expensive city statewide, while in Colorado Springs the median rate is $5,829 per month.   

The Cost of Memory Care in Colorado

Colorado's Medicaid system, known as Health First Colorado, doesn't directly pay for room and board in alternative care facilities (ACF) that offer memory care or have Alzheimer's special care units (SCUs). However, it can cover some personal care services that residents with Alzheimer's disease and dementia receive, including grooming, bathing, housekeeping and mobility support, through the Elderly, Blind and Disabled Waiver (EBD).

Elderly, Blind and Disabled Waiver

The Elderly, Blind and Disabled Waiver is intended to help seniors aged 65 and older who are at risk for nursing home placement. It provides the services these seniors need to delay or prevent the need for institutional care. In addition to receiving regular medical benefits through Health First Colorado, those accepted into the waiver program can receive 24-hour oversight, medication administration, nonmedical transportation, transition services, electronic monitoring and various other services provided in a memory care setting.

• Who Is Eligible: To qualify for the EBD Waiver, residents must have a low income and be aged 65 and older with a significant functional impairment. Disabled applicants aged 18 through 64 are also eligible. All applicants must be assessed as needing a nursing home level of care.
• How To Apply: Applications can be submitted online through the Colorado PEAK system, in person at the local county Human Services Department office or over the phone by calling (800) 221-3943. An application can also be printed, completed and mailed to the address listed in the form's instructions.

Medicaid Eligibility for Seniors in Colorado

The eligibility for Medicaid in Colorado is based on 300% of the federal poverty level. In 2022, a single applicant can earn up to $30,276 per year and own up to $2,000 in assets. In a two-person household where both members are applying, the income limit is doubled, and the asset limit is $3,000. When only one household member is applying for Medicaid, the applicant may have up to $30,276 in income and $2,000 in assets. The non-applicant's income isn't counted, and they can have up to $137,400 in assets.

2022 Medicaid Income Limits for Seniors in Colorado

Applicant must meet other eligibility criteria in addition to functionality, income and assets, including:

• Having U.S. citizenship or legal resident status
• Being a resident of Colorado

How To Get Help Applying for Medicaid in Colorado

The following resources may help seniors and their families understand the available benefits and apply for Medicaid coverage for memory care services.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

Memory care is generally provided in residential care facilities, commonly known in Colorado as assisted living residences and alternative care facilities. The Colorado Department of Public Health and Environment is responsible for the regulation and licensing of assisted living. The state requires facility administrators to be certified in the scope of care provided, such as having a background curriculum that covers Alzheimer's for an administrator of a memory care facility. New staff members must also receive training related to the specific needs of the resident population.

Facility Scope of Care

In Colorado, assisted living residences and alternative care facilities aren't permitted to provide a high level of nursing care on a full-time basis, such as the level of care in a nursing facility. However, residents can receive short-term and moderate nursing care if needed while remaining in the facility. This allows memory care to be provided in an assisted living setting for the majority of people.

Residents of ALRs and ACFs are entitled to:

• All meals and assistance with activities of daily living
• Medication administration and homemaker services
• 24/7 security, social care and supervision

Admissions Requirements

Each facility sets its own admission requirements, and management is required to produce a copy upon request. For example, alternative care facilities (ACFs) are certified to accept Medicaid members, while other facilities are specialized in nature and only accept people who benefit most from the services provided, such as people with Alzheimer's.

Residents Who May Be Admitted

People who are:

• Physically disabled or blind
• Diagnosed with Alzheimer's or related dementia
• Diagnosed as mentally ill
• Receiving behavioral treatment

Residents Who May NOT Be Admitted

Those who:

• Cannot be prevented from harming self or others
• Need permanent nursing care
• Have needs that can't be managed safely

Care Plan Requirements

Colorado's regulations require an initial assessment to be performed on each new resident of an assisted living facility, and this is used to formulate a care plan for the individual. This plan must be worded clearly, using terminology that the general public understands, and it must be made available to the resident, family members or authorized agents upon request. Residents with a specific health issue, such as Alzheimer's disease, must be placed on a care plan that provides appropriate services and amenities, and this includes an appropriate set of activities for the resident's physical and cognitive function.

Medication Management Requirements

Prescription and nonprescription medication must be ordered by an authorized practitioner, clearly labeled with the individual's full name and stored on-site in a secure location. By default, residents of assisted living facilities are entitled to keep and manage their own medication, which is known as self-administration, although this is less likely in a memory care situation due to declining cognitive function. Residents who are assessed as unable to self-administer must be assisted or have their medication administered by a nurse or qualified medication administration person (QMAP). If a resident cannot self-administer and the facility has no QMAP, the resident must be discharged.

Facility Requirements

State regulations require that assisted living facilities be properly and safely maintained, which includes the exterior grounds, resident areas, staff rooms and storage spaces. Facilities must also maintain an ability to properly serve the resident population, such as having at least two wheelchair-accessible entry and exit points if there are any residents using wheelchairs and having handrails on all staircases. Common areas and dining rooms must meet accessibility standards. Private bedrooms must be at least 100 square feet or 60 square feet per occupant in a shared bedroom, and the maximum occupancy is two. There must be a minimum of one bathroom for every six residents, with at least one bathroom for every floor that houses residents.

Staffing Requirements

The Code of Colorado Regulations states that an assisted living residence must have at least one staff member on duty at all times who is capable of performing CPR. Beyond this minimum, the facility administrator must devise a plan for routine staffing levels that takes into account the number of beds, the health condition and needs of residents, as well as the set of services outlined in the resident agreement and care plan. The appropriate routine staffing level is assessed and ultimately determined by state regulators.

Medicaid Policy

In Colorado, Alternative Care Facility (ACF) is a term used specifically for assisted living facilities that are certified for Medicaid reimbursement by the Department of Health Care Policy and Financing. In most cases, a resident of an ACF who is enrolled in Medicaid will be covered for all personal care services received in the facility, such as mobility assistance, hygiene or help getting to appointments. However, the cost of room and board isn't covered by Colorado Medicaid or its waiver program.

Reporting Abuse

Colorado has strict policies and severe penalties for facilities, staff and administrators who abuse residents, whether emotionally or physically, or create unsafe environments for residents and other staff. Management must report any allegation of abuse against a resident to their family or emergency contact within 24 hours. Members of the public who wish to report an issue in an assisted living facility should contact the Health Facilities Department at (303) 691-4045 or submit a complaint form online. Fax, email and postal options are also available. Criminal allegations should be followed up with the police.

The following free and low-cost resources can help Colorado residents learn more about the available long-term care options or find memory care services in their community. They can also find resources that can help with the transition to memory Seniors and their loved ones in Alabama will find a variety of resources to provide information, support and assistance as needed.

Note: The following information was compiled and most recently updated on 2/2/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.