Colorado Advance Directives in Hospice, Nursing Homes, and Assisted Living

Your advance directive doesn't just sit in a drawer — it follows you through every care transition. But each setting handles these documents differently, and gaps in coordination during transfers are where family wishes fall through the cracks.

Hospital Admissions

Colorado hospitals are required to ask about advance directives upon admission. The admissions department will request copies of your Medical Durable Power of Attorney (MDPOA) and Living Will to scan into your electronic health record. Major systems like UCHealth, Banner Health, and Kaiser Permanente store these in their patient portals (MyChart or the equivalent).

If you're admitted without directives and become incapacitated, the hospital must follow Colorado's Proxy Decision-Maker Act (C.R.S. § 15-18.5-103) — contacting all "interested persons" and requiring unanimous consensus before proceeding with treatment decisions. This process can delay critical care by hours or days if family members disagree.

The critical timing issue: if your Living Will specifies withdrawal of life-sustaining treatment, the hospital cannot act on it until two physicians certify in writing that you are terminally ill or in a persistent vegetative state. After that certification, a mandatory 48-hour waiting period applies before treatment withdrawal begins.

Nursing Home and Assisted Living Facilities

Under C.R.S. § 15-18.7-108, no Colorado nursing home or assisted living residence can require completion of a MOST form as a condition of admission. This is a common misconception — facilities strongly encourage these documents, but cannot legally mandate them.

However, what facilities can and do require is documentation of who holds medical decision-making authority. Without an MDPOA on file, staff face delays when they need consent for treatment changes, medication adjustments, or emergency transfers.

When a resident transfers between facilities — from assisted living to a skilled nursing facility, or from a nursing home to a hospital — the MOST form travels with them. It's the one advance planning document designed for portability across care settings. Upon admission to any new facility, the care team must review the MOST form with the patient (or their agent) to confirm it still reflects current treatment goals. This review is documented on the back of the form.

Hospice Care at Home

Home hospice creates a unique gap in the advance directive system. Your Living Will addresses hospital-level decisions about life-sustaining treatment. But at home, the immediate concern is different: what happens if a cardiac event occurs and someone calls 911.

Colorado law requires EMTs to perform full CPR unless they are presented with a state-standard outpatient CPR Directive or a MOST form ordering "No CPR." These documents must be physically visible — on the refrigerator, by the bedside, or on the inside of the front door. A Living Will alone is not sufficient to prevent emergency resuscitation.

The hospice team will typically help coordinate a CPR Directive or MOST form with the attending physician. But families sometimes enter home hospice before this step is complete, creating a window where emergency responders would be legally required to resuscitate and transport to the hospital — exactly the scenario the family is trying to avoid.

The Transfer Gap Problem

The most dangerous moment is during transfers between settings. A patient discharged from a hospital to home hospice may lose their in-hospital DNR order (which expires upon discharge) without having a portable CPR Directive in place. A nursing home resident transferred by ambulance to a hospital may arrive without their MOST form if it wasn't included in the transfer packet.

To prevent these gaps:

• Ensure the CPR Directive or MOST form physically accompanies the patient during any transport
• Confirm that the receiving facility has current copies of the MDPOA and Living Will before discharge
• Ask the sending facility to fax or securely transmit documents to the receiving facility's medical records department
• Keep a copy of all directives in the patient's personal bag or with the accompanying family member

Provider Conscience Objections

If a healthcare provider at any facility has moral or religious objections to honoring a patient's treatment choices (on a MOST form or Living Will), Colorado law does not allow them to simply refuse. They must arrange for a prompt transfer to another provider or facility that will carry out the patient's documented wishes.

The Colorado Advance Directive & Living Will Kit includes a document distribution tracker and care-setting transition checklist so your directives follow you through every transfer without gaps.

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