What to Expect
For their own safety -- and the safety of others -- a person with progressive dementia will eventually need 24-hour supervision. He or she will also need help with:
- Personal Care,
- Medication Management, and
- other Activities of Daily Living (ADLs).
At first the individual might be able to live at home with help from loved ones. Family can get support from in-home care providers and adult day care. But as dementia progresses and the patient's needs grow, the spouse or other unpaid caregiver can become exhausted; we can only be superhuman for so long. Choosing a memory care facility becomes the best option. Most memory care centers are specialized nursing homes or specialized areas of nursing homes. Assisted living communities increasingly have memory care divisions too. Memory care centers ensure that residents won't wander away; exits are carefully monitored. Employees and visiting specialists facilitate daily social events and potentially therapeutic activities. They provide meals, health care and personal care. All states regulate and license senior care centers, but many states lack special criteria for memory care nursing homes. It's important to compare facilities carefully. A standard rundown of memory care services includes:
- A private or semi-private room
- 24-hour personal assistance
- Three daily meals
- Medication management
- Cognitive and physical therapies
- Exercise activities
- Social activities
- Housekeeping and laundry
Choosing a memory care facility can be emotionally exhausting, but spending time on research can make a difference to your loved one's quality of life and your family's financial security. This article can streamline your task with an overview of what you need to know about when memory care is needed, what services are available, typical costs and payment solutions.In This Article:
Who Needs Memory Care? ↓
Costs of Memory Care Centers ↓
How to Pay for Memory Care ↓
Questions to Ask Care Providers ↓
Who Needs Memory Care? Ten Questions to Consider
When symptoms of Alzheimer's and other dementia first appear, they might be mistaken for normal aging. When symptoms progress, caregivers might be unsure about whether memory care is needed. It's important to know that early intervention can lessen symptoms and delay progression of the disease. Medication and other therapies can help people live at home safely and comfortably for longer. Visiting a primary care doctor about the symptoms can be life-changing. Eventually though, a person with dementia will probably need 24-hour supervision. This usually becomes essential for their own well-being and the safety of others. Here are questions to consider if you're wondering whether a loved one should move to a memory care home.
- Has he or she gotten lost in previously familiar territory, as when taking a walk in their neighborhood or running errands?
- Can your loved one state their phone number and address in case they need help returning home?
- Does the person forget to lock their doors, making themselves vulnerable to crime?
- Have they forgotten to turn off a stove or other potentially dangerous appliance?
- In case of fire, do you believe he or she would handle the situation safely?
- Has your loved one's level of personal care declined? For example, are they "not themselves" in terms of bathing, dressing or eating?
- Is he or she taking medications as scheduled? Are you confident they'll take the correct dosages?
- Has he or she become uncharacteristically suspicious or fearful of others?
- As a caregiver, are you risking your own health? Are your caregiving duties interfering too much with your other responsibilities?
- Could your family pay for the amount of skilled in-home care or adult day care required? A limited amount of respite care could be available for free or at low cost. If extensive help is needed though, a memory care facility could be more affordable.
Costs of Memory Care Centers
Compared with traditional assisted living or nursing home care, memory care tends to cost more. That's because memory care patients require more supervision and need caregivers with more advanced skills, especially as dementia becomes more serious. Typical prices for residential care range from about $3,000 to $6,000 per month. On the other other hand, respite care may be low cost or free. Respite care is temporary help for the primary caregiver. Assistants visit the home and/or provide services at an adult day care center. Private organizations and government groups at the federal, state and local levels offer respite care. Two federally funded programs to research are Lifespan Respite Care and the National Family Caregiver Support Program.
What Shapes the Cost of Residential Care?
Many factors influence the cost of residential memory care, but geography plays a key role. A region's general cost of living of course figures in. Population density matters too. For example:
- Memory care is generally more expensive in the northeast than in the southwest because workers need higher wages to survive.
- Memory care is generally more expensive in remote areas (e.g., rural Alaska) because agencies need to pay more to attract skilled workers.
When family members are spread out across the country, sometimes it makes sense to compare the costs of memory care centers in each hometown. Costs are also higher for care services with a private room versus a semi-private room. Room size and facility amenities are important factors too. The typical resident stays in a memory care home for fewer than 12 months, according to the National Center for Assisted Living. However, some stay for much longer.
How to Pay for Memory Care
Long-term senior care can be paid for privately and/or with public funds. Paying for memory care out-of-pocket gives patients and their advocates the most freedom in terms of choosing providers. When personal funds can't cover expenses, resources from the government and nonprofit foundations can help meet the need. Reputable memory care centers can guide you through options. You can also hire an estate planner, geriatric planner or similar finance expert. Here we introduce key payment solutions.
Private Pay ↓
Long-Term Care Insurance ↓
Medicaid & State Programs ↓
Veterans Benefits ↓
Paying for memory care on your own saves a lot of paperwork and proverbial red tape. For example, it lets you skip applications for aid. It can also help keep your loved one off a waiting list; long-term care facilities can limit the number of rooms available to Medicaid or Medicare patients. Payment might be accomplished with a combination of sources such as:
- Family income
- Savings and annuity payments
- Cashing out investments
- Borrowing from life insurance
- Selling a home
- Getting a reverse mortgage
Medicaid is available to people who have exhausted their other payment resources. To qualify for Medicaid, yet still keep wealth in the family, sometimes a person can minimize their assets in specific ways. An estate planner or geriatric planner can provide personalized advice. Here are some general points about personal payment sources mentioned above.
Savings & Annuities
When a person has a good deal of savings, buying an annuity can help ensure that the nest egg lasts. When you buy an annuity, you pay a lump sum and then receive monthly payments for the rest of your life. The monthly payments might not cover all living expenses, but they ensure regular income nonetheless. Another benefit of buying an annuity is that the lump sum paid is shielded from consideration on Medicaid applications, although the monthly annuity income needs to be reported.
Borrowing from Life Insurance
Life insurance policies that are "whole" rather than "term" can be tapped to help pay for memory care and other senior health care needs.(A term life policy can be converted to a whole life policy to take advantage of these options.) The three options with a whole life policy are:
- cashing out
- selling the policy to a third party
- converting the policy from insurance to "assurance"
A portion of each whole term life insurance premium payment is put into savings. One option for memory care payments is cashing out a life insurance policy to access the accumulated savings. This is called getting "accelerated" or "living" benefits. A fee for cashing out diminishes the return though; the policyholder will receive a lump sum that's worth about 50 to 75 percent of the actual amount saved. Another option is to sell the policy to a third party specializing in life settlements or senior settlements. This would give the original policyholder a lump sum of cash. The buyer would then take over the premium payments and take the financial benefits when the person passes away. Converting a life insurance policy is another option. Life insurance conversion or "life assurance" might greatly reduce the overall value of a policy, but it will let funds be used for memory care. At the same time it will preserve the death benefit for the policyholder's beneficiaries, which isn't the case in the other scenarios. .
Selling a Home
Selling the senior's home can relieve a family's financial worries regarding memory care. Still, ideally the home wouldn't be sold in a rush. One option is to secure a bridge loan. A bridge loan assumes that the home will sell, and it can pay for memory care and other needs until the home sale money is received. Often the first loan payment isn't scheduled for 90 days. For a family member instead of the homeowner to handle the sale, power of attorney or guardianship will need to be granted.
Getting a Reverse Mortgage Loan
Reverse mortgage loans let homeowners borrow money for senior care. The maximum amount available equals the accumulated equity in the home. The main advantage of choosing a reverse mortgage for long-term care is that while one spouse moves to a memory care facility, the other half of the couple can keep the home. The main disadvantage of a reverse mortgage is that the loan becomes due when the second person no longer lives in the home. In most cases the home must be sold in order to cover the loan payment, so reverse mortgages aren't the best choice when the objective is keeping property in the family.
Long Term Care Insurance
Long term care insurance can pay partly or entirely for memory care and other long-term senior care. Having long-term care insurance gives patients more flexibility in choice of residence compared with using taxpayer funds. An insurance policy must be purchased years before the benefits are needed. Generally the best strategy is to buy long-term care insurance in your fifties because the rates will be lower compared with buying a policy later. Adding a bit to your premium by opting for inflation protection can save you thousands in the long run; it's not uncommon for rates to increase by five percent or more per year. A long-term care policy will generally have restrictions about when residential care will be provided. Normally the requirements aren't difficult to meet in the case of patients with Alzheimer's and other dementia. A typical standard for coverage is that the individual needs help with at least two activities of daily living according to a doctor's analysis. A diagnosis specific to memory loss or cognition may not be required.
Medicare offers very limited assistance to the typical senior in need of memory care. To qualify for Medicare coverage initially, a person needs to require a minimum of a three-night stay in a hospital. For that coverage to continue, they'll need to require intensive assistance but not custodial care (long-term care regardless of medical need). Medicare will pay for up to 100 days of medical care in such cases. If care in a psychiatric hospital is needed, the limit is extended to 190 days. Note that Medicare is almost exclusively for medical care. Medicare will not pay for personal care, for instance, unless it's part of hospice care in the last six months of life. Supplemental Medicare insurance, or Medigap, will typically pay 20 percent of the nursing home care bill not covered by Medicare. Often dementia patients meet the Medicare criteria for a short period of time but then move into the "custodial care" category. In such cases a new form of payment is generally required. When the individual cannot cover payment privately, families in some states are eligible for a Medicare-Medicaid partnership program called Program of All-Inclusive Care for the Elderly (PACE). PACE provides adult day care and in-home care.
Medicaid & State Programs
Medicaid is funded federally and by the states. Each state operates its Medicaid program separately, and memory care benefits vary accordingly. States can support a wide variety of medical and non-medical assistance programs with their federal dollars. Unfortunately these programs have enrollment caps and seniors are sometimes put on waiting lists. While some Medicaid patients live in nursing homes, others use a state Medicaid waiver program to receive personal care services at home. Most states use the Medicaid Home and Community Based Services Waiver, or HCBS Waiver, for this purpose. These services are not specific to Alzheimer's and other dementia. A person getting these services would not get the various therapies offered at high quality homes, unless those therapies were provided by others. Additionally many states have their own assistance programs for low-income people who need help with activities of daily living. These programs aren't necessarily tailored for those in need of memory care. Many are designed to help delay or prevent moving to a nursing home. The following examples show a wide range of non-Medicaid state program benefits:
- The Alaska Senior In-Home (SIH) Services program provides daily living assistance to all low income state residents ages 60 and older with limited mental or physical capabilities. This program is meant for people who do not qualify for Medicaid but cannot afford to pay privately for care.
- The California Paid Family Leave (PFL) Act lets employees take time off of work (up to six weeks per year) and receive compensation for their caregiving. The wage replacement can equal up to 55% of one's job income. This program does not guarantee job security. New York has a similar law scheduled to take effect in steps from 2018 to 2021. Ultimately the New York Paid Family Leave Benefits Law (PFLBL) will provide caregiving wages for up to 12 weeks per year, although some employers may opt out.
- The Wisconsin Alzheimer's Family and Caregiver Support Program (AFCSP) provides respite care services to low and middle income families affected by Alzheimer's disease, dementia and other memory disorders. In-home care and adult day care are offered. Unlike with Medicaid, individuals do not need to spend most of their savings to become eligible.
Veterans who need memory care can get tailored skilled nursing services through the Veterans Administration (VA) as described below. Their families can also take advantage of VA respite care. Depending on geographic region and the family's preference, respite care can be provided in the home, in adult day care or elsewhere in the community. A veteran who does not have a spouse or other caregiver may qualify for the VA's Community Residential Care (CRC) program. CRC is specifically for veterans who do not need nursing home care yet cannot live at home because of medical or cognitive/psychiatric conditions. The care can take place in an assisted living center, a group home, a psychiatric residential care home or similar setting. More than 1000 locations across the country are approved by the Veterans Administration, and veterans can choose from any of the facilities. If more advanced care is needed, the Veterans Directed Home and Community Based Services (VD-HCBS) can step in. VD-HCBS lets veterans who are candidates for nursing home placement to receive skilled care at home or in independent living communities. Veterans receive funds to essentially become employers; they are free to choose their own care providers In some cases family members can be paid for their caregiving. Another benefit for veterans and their surviving spouses is an increase in the Aid and Attendance pension based on caregiving needs. Aid and Assistance increases are based on financial need and require a doctor's recommendation. State-level programs such as California's CalVet also offer supervised environments and high-level care for vets dealing with confusion and other symptoms of dementia. To learn about these benefits and other memory care for veterans, contact the VA.
National nonprofit organizations give grants for respite care. Some give caregiving funds directly to families. Others grant the funds to local nonprofits and care providers for distribution. To learn more, you can start by contacting the Alzheimer's Foundation of America and the Alzheimer's Association.
Questions to Ask Memory Care Centers
Touring memory care centers, it's best to collect facts and also trust your intuition or "gut feeling." Here are questions to ask when you visit a facility.
- How is the memory care center secured? This question relates not so much to safety from intrusion, but a resident's safety against exiting the facility. Protecting the residents against "exit-seeking behaviors" is a main benefit of a memory care center. Most facilities have their entrances locked 24/7 and keep any elevators for staff and visitors carefully monitored as well. In some facilities each resident wears a bracelet with an electronic sensor. Additionally a resident can have a personal security alarm on his or her bed and/or wheelchair. A personal security alarm can alert a staff member in case a patient tries to stand up without remembering that they require assistance.
- When do residents get exercise and fresh air? Memory care homes need to guard against exiting, but ideally the residents have a secure outdoor area for getting fresh air and recreation. Circular paths for walking, both inside the facility and outdoors, are common in the best facilities for dementia patients.
- Does the facility have structured daily activities? Structured activities led by skilled nurses and therapists can greatly improve a person's quality of life. In the best facilities each day has a full programming calendar. For example, residents might get art therapy, bake bread and cookies, sing, and visit with a therapy dog. The facilitated activities are designed to help keep residents' minds active and lessen symptoms of decline. This sort of memory care might also help slow the progression of dementia.
- Are psychiatric and psychological services provided? Many memory care centers have staff or visiting specialists to help with residents' psychological needs on a one-on-one basis. These caregivers can provide therapy and help patients establish or adjust a medication regimen as their disease changes.
- Do physicians and other medical specialists visit the facility? Such visits can make life easier by eliminating the patient's need for transportation to a clinic.
- What training do the caregivers receive? Ideally a registered nurse will be on duty 24 hours/day, as residents could have medical emergencies at any time. Ask for the hours of skilled nursing, and also ask about the training that personal caregivers receive. What are the criteria for getting hired? How are staff trained once hired?
- What is the ratio of staff to residents? Memory care costs more than standard nursing home care partly because a higher ratio of staff to residents is needed for safety and comfort. Ask for the staffing ratios for daytime and night.
- Does each resident have a customized care plan? Alzheimer's and related diseases develop differently for everyone, so the best care for dementia patients is highly personalized. It's also good to ask whether residents are grouped by cognitive level.
- What is the discharge policy? Residents of a senior facility, like residents of any mainstream apartment complex, can be evicted. This might happen if the resident becomes physically aggressive or otherwise disrupts the community. With memory care patients, disruptive behaviors are more likely regardless of the residents' temperaments when they were more "themselves." Be sure to ask how the staff is trained to respond in case your loved one or another resident exhibits disruptive behaviors, and get a full understanding of the center's policies for discharge.
- What type of care is the facility unable to provide? Understanding the center's criteria for involuntary discharge can help you understand what sort of care they cannot provide. Also be sure to understand whether they'll be able to continue caring for your loved one if he or she becomes bedridden or needs to use a wheelchair. You might also want your loved one to live at a facility that has a snoezelen room, which uses sight, sound, and other senses for memory therapy. Some patients would also benefits from Parkinson's therapy and other specific care options.