As the population of older Coloradans increases, the senior living industry is providing more choices.
The Pikes Peak region has seen a lot of growth in large, private-pay, corporate-backed assisted living communities, where residents occupy small apartments and have access to on-site dining services and a range of amenities. Options for in-home care, such as housekeeping and home health services, also are growing.
Another alternative for people who can live independently but may need some help with their daily activities is assisted living homes accommodating 16 or fewer residents. These homes are becoming increasingly popular with older people who want to feel like they are part of a family.
“They allow people to have a homelike environment and also are more affordable,” said Christel Aime, who owns and manages 11 assisted living homes in El Paso and Douglas counties. “We appreciate the luxury [assisted living facilities] out there, but to me they look like hotels. We make sure our homes look like home.”
Assisted living as a business
Aime’s flagship home, Solange on Golf Course, is indistinguishable from others in its Southeast Colorado Springs residential neighborhood, except for a small sign out front. It has a bright living room where residents can congregate, watch TV or nap on couches while aides prepare their lunch in the modern kitchen. Meals are served in a sunny, adjacent dining room, and a deck and landscaped back yard overlook the mountains.
Until 2012, when he purchased his first building, Aime worked as a nurse in hospital and nursing home settings. He also taught medication classes through the Colorado Department of Public Health and Environment for people working in assisted living.
He was working at Penrose Hospital and also operating a home care agency when he bought the house that became Solange, which was named after his Haitian mother. Two years later, Aime purchased another, larger group home in Security.
“I lived [at Solange] for six years,” he said. “I was the administrator and caregiver, and my wife helped as staff. We pretty much ran them as mom-and-pop homes.”
Within a couple of years after purchasing the second home, Aime quit his job at the hospital. He acquired three more places in Colorado Springs and six homes in Douglas County.
The Douglas County homes “were not being run too well and were failing,” he said.
The homes, which had been bought by off-site investors, were dirty and smelled bad; they lacked a proper business structure and qualified staff.
“Staff is what makes the difference,” Aime said. “We have good people here who are really caring and put their heart in it.”
He acknowledges that finding the right caregivers to perform what can be a difficult and demanding job is a challenge and admits he is fortunate to be able to draw upon the students in his classes.
“I am finding out that immigrants are the best caregivers,” he said. “We have some American staff, but it is just getting more difficult to get Americans to do caregiver jobs. … The pay has not increased tremendously in the last 20 years, so most people are walking away from these jobs.”
Building from the ground up
Like Aime, Steve Feldman has to conform to the same state regulations at his two group homes that the bigger, institutional assisted living facilities must follow. But instead of nursing, he brought a background in construction to his enterprise, New Day Cottages in north Colorado Springs.
In 2008, when he purchased his first group home, “I was open to doing something different,” Feldman said. “I was introduced to assisted living and did some research on the north end of Colorado Springs. We really weren’t doing a good job with residential homes. My wife and I decided we’d take it on.”
Feldman bought a house on Turner Road, gutted and completely renovated it with the safety of older people in mind, and opened it in 2009. He purchased a second property in the Falcon Estates neighborhood in 2014, demolished the existing home and built a new one. Together, the two homes house 27 residents.
“There is a lot involved in it,” Feldman said. “Because of having worked with government agencies, I was reasonably comfortable dealing with all the rules and regulations. It was a matter of jumping in and taking an administrative class in Denver to learn what the requirements were.”
Feldman serves as administrator, with assistance from his wife. Staff includes an activities coordinator who also helps with marketing, on-site managers, and caregivers with CNA training who assist residents with medications, use of oxygen and assistance with daily activities such as bathing, dressing and personal hygiene.
“We have our eyes on residents every two hours,” he said. “In a smaller facility, we are able to identify problems quickly and make sure they get handled.”
“What I like best is seeing our residents enjoying the company of each other as a family and seeing their quality of life improve when they move in,” he said. “That’s the key element of what you can do at a smaller facility.
“The big places have their place and do a good job of a restaurant-quality experience for meals and a resort type of feel, but a lot of people want to feel like they’re in a home and want more of a family setting.”
Feldman notes that most group homes are less expensive than the big facilities. All assisted living facilities charge a base rate plus fees for additional services. Monthly rates can range from $2,400 to $7,000.
“Our reservation fee is $500,” he said. “The big places are $2,000-$5,000. There’s so much overhead and so many levels of management with the big ones. One of their biggest challenges is to have folks on the floor who have the ability to actually make a difference in folks’ lives as opposed to dictating what they’re going to do.”
Feldman thinks group assisted living is a good business “if you’re doing everything right and you keep your places full. We still have high overhead and staffing costs … [but] we were over 96 percent full for the entire year in 2018.”
Assisted living evolved in the 1980s as an alternative to the highly regulated nursing home model, which provides skilled nursing care, short-term rehabilitation and long-term care for people who are extremely frail. Assisted living offers residents a greater degree of independence and self-determination.
All assisted living facilities in Colorado are governed by state regulations that require providers who care for three or more individuals to be licensed, said Scott Bartlett, long-term care ombudsman at the Pikes Peak Area Council of Governments Area Agency on Aging. The law provides certain protections for residents.
“If a facility initiates a discharge, a process has to be followed,” Bartlett said.
Administrators must complete the state course and demonstrate competence and knowledge of the regulations, which also govern how medication is administered and dietary guidelines that must be followed.
According to the Colorado Department of Public Health and Environment, there are 71 assisted living facilities in El Paso County. Of those, 35 are private-pay only, and 36 accept both private-pay and Medicaid patients. The private-pay facilities generally house 16 or more residents and are either part of a larger retirement community or standalone assisted living facilities.
Bartlett said most of the recent growth in El Paso County has been in large, private-pay buildings.
“A lot still have open beds, and a lot are preparing for future needs for that level of care,” he said.
While he thinks assisted living beds currently are keeping up with the demand, he foresees continued growth in home care agencies and smaller facilities that serve older people with more limited resources.
“Citizens of the region want to have choice,” he said.
Disclosure: Jeanne Davant chairs the Age-Friendly Manitou Springs committee.