In Arizona, “assisted living facilities”(ALFs) provide a comfortable, homelike living setting (lodging and meals) for seniors and disabled individuals who require supervision and assistance to live independently. “Assisted living facilities” is a broad term that includes several residential settings that are categorized by the size of the residence and the level of care that is provided. The categories of ALFs include adult foster care homes, assisted living homes, and assisted living centers. In adult foster care homes, as many as four residents live with the caregiver in his/her home, assisted living homes accommodate up to 10 residents, and assisted living centers house a minimum of 11 residents.
Assisted living residences in Arizona are licensed to provide a specific level of care: Supervisory, personal, or directed. In supervisory care, which offers the lowest level of care assistance, the needs of the residents are monitored, assistance with administering one’s own medication is provided, and help is available in the event of an emergency. In a residence that offers personal care services, one can expect assistance with activities of daily living (ADLs) like bathing, dressing, and mobility (getting up from a chair/bed, walking, etc.), occasional nursing services, and dispensing of medications. Directed care provides the highest level of care and is for residents who are unable to communicate their needs, ask for assistance, or make decisions in regards to their basic care.
Assisted living residences that are designed and staffed specifically for persons with Alzheimer’s and other dementias are often referred to as Alzheimer’s care, dementia care, or memory care. In Arizona, the residences that provide care for persons with such neurological conditions are directed care residences. These types of homes in Arizona differ from traditional assisted living in several ways. These include increased security and supervision, additional staff training, recreational activities specific for persons with dementia, and of course, cost. A point of distinction should be made that Memory care homes are not nursing homes. Generally these residences are less expensive and offer a better quality of life to their residents.
Due to the added level of security and supervision of memory care homes in Arizona, this type of care generally costs several hundred dollars more per month than does traditional assisted living. Statewide in Arizona, as of 2019, the average cost of memory care is $4,484 / month, but based on the geographic location in which one resides, the average cost may be as low as $1,793 / month and as high as $9,060 / month. The most affordable areas of the state are Lake Havasu City ($4,130 / month, on average) and Yuma ($4,277 / month, on average). Tucson has an average monthly cost higher than the statewide average at $4,771 / month, but even so, the average monthly cost ranges from $3,228 to $7,965 in this area. The most expensive region of the state is Flagstaff, with an average monthly cost of $6,015.
In Arizona, memory care homes for persons with dementia must be physically constructed for the safety and wellbeing of persons with the disease. For instance, memory care residences might have an enclosed outdoor area to prevent wandering. In addition, activities specifically geared towards persons with dementia are required, as well as the availability of staff around the clock. All ALFs must have a manager that oversees it. In order to fill this role, one must be a minimum of 21 years old and must have an assisted living facility manager certification.
All assisted living facility employees must be CPR and first aid certified. Those who provide resident care assistance (formally called caregivers) must be a minimum of 18 years old and have 3 months of experience in the healthcare field. Assistant caregivers need only be 16 years old. For all positions, staff must undergo training specific to the level of care (supervisory, personal, or directed) provided at the residence in which one is employed. Employees working with persons with Alzheimer’s disease and related disorders in directed care residences must have training specific to working with this population.
Required number of hours of initial staff training is as follows: Supervisory care (20 hours), personal care (50 hours), and directed care (62 hours. Remember, memory care facilities offer this level of care). Managers require additional training, which comes to a total of 69 hours. Annual training is also required for all staff (6 hours / year). Those who work in a residence that provides a personal care services level of care must take another 2 hours of training on an annual basis, and those who work in a directed care services residence must take another 4 hours of training each year.
Arizona does not have a set staff to resident ratio for assisted living residences. Said another way, residences are given the flexibility to decide the number of staff that is required to meet the needs of the residents. Residences that cater to persons with dementia require more staff than do residences that serve people with less demanding needs.
In Arizona, in order to be admitted to an assisted living residence, including memory care, there are several requirements that one must meet. These include the following:
In addition to the above, new residents must be assessed within 14 days of admission and a care plan made. Service plans must be reviewed and revised on a consistent basis: Every 3 months for residents residing in a direct care residence, every 6 months for those in a personal care residence, and once a year for those who are in a supervisory care residence.
In most cases, a family will spend several weeks deciding which assisted living residence is best for their loved one. They then will spend several more weeks relocating their loved one and getting him/her settled in. Many assisted living residences have waiting lists, and therefore, admission is not always immediate.
While the cost of memory care can be quite expensive, financial assistance is available for low-income persons who need it.
Medicaid is a jointly funded federal and state program, and in Arizona, it is called the Arizona Health Care Cost Containment System (AHCCCS). However, the program that provides long term home and community based services via AHCCCS is the Arizona Long Term Care System (ALTCS). While many states offer home and community based services (HCBS) via HCBS Medicaid waivers, which limit the number of program participants, services and supports via ALTCS are available to all eligible applicants. In addition to covering the cost of nursing home care, ALTCS will cover the cost of supportive services in a variety of settings, such as one’s home, adult foster care, and assisted living. To be clear, this program will not cover the cost of room and board in assisted living facilities (or memory care units for persons with dementia), but will offer assistance for care services. More on Medicaid eligibility.
While not limited to Arizona, the VA offers an Aid & Attendance (A&A) pension for veterans and surviving spouses who receive either the basic VA pension or the basic survivor’s VA pension. Applicants must be at least 65 years of age or disabled and require assistance with completing activities of daily living, such as mobility, transferring, eating, and bathing. The monthly cash assistance received from these pensions can be used as the recipient see fits, which means it can go towards the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing one’s countable income when determining one’s pension benefit amount. In 2019, veterans can receive as much as $26,765 / year, and surviving spouses can receive as much as $14,529 / year that can be put toward the cost of memory care. Learn more here.
There are also state Veterans homes, which are residential care facilities that provide long-term care for veterans. In addition to nursing home care, assisted living and memory care may be provided. Payment is made directly from the VA to the facility.
While Arizona’s Home and Community Based Services Program does not help to cover the cost of assisted living (or care services in assisted living), it is beneficial for persons with dementia who require assistance with daily living activities and would otherwise be able to continue to live at home, or with family, if care assistance were provided. A collaboration between the Arizona Department of Economic Security and local Area Agencies on Aging offices, a variety of supportive services are available, which includes meal delivery, housecleaning, personal care assistance, adult day care, and respite care.