Assisted living homes in Indiana are described in regulations as “residential care facilities,” which provide rooms, meals, and healthcare based on residents’ needs. Residential care facilities may offer nursing care, and must assist residents with activities of daily living (ADLs) like bathing and eating.
Within Indiana assisted living homes there may be special programs or units for people with Alzheimer’s or related dementia. These special care units (also called memory care) have additional requirements. Anyone considering living in one of these homes is entitled to a state-approved disclosure form that lists the following:
– The mission or philosophy on treating residents with dementia
– The criteria used to determine that a resident is suitable for memory care
– A process for assessment, and implementation of a special care plan
– Staff information including the number of employees and their training
– Description of frequency and types of activities
– Rules for use of physical or chemical restraints
– Itemized list of all charges and fees
– Anything else specific to memory care
There are also additional requirements for administrators and staff if a residence serves people with dementia (see Staff & Training below).
Assisted living homes in Indiana are regulated by the Indiana State Department of Health (ISDH) and the Indiana Family and Social Services Administration. Annually updated disclosure documents are kept on file at the Division of Aging.
The average cost of memory care per month in Indiana is $5,384, which breaks down to about $177 per day and $64,608 annually. Remember that residential care facilities in Indiana are required to provide an itemized list of all charges and fees, so there should never be any surprises when it comes to paying for costs in memory care. Assisted living, without the additional services required for memory care, costs Indiana residents about $4,115 per month and $49,368 annually.
The state’s most expensive place for memory care is Muncie, running $7,459 per month and $89,508 annually. The least expensive is Bloomington, for $3,909 per month and $46,908 annually. Indiana’s biggest city, by far, is Indianapolis, where memory care costs are about the same as the state average of $5,384 monthly and $64,608 yearly. Fort Wayne, the state’s second-biggest city, costs about $4,786 monthly and $57,432 per year.
A resident cannot be admitted under these circumstances:
– Is dangerous to self or others
– Requires 24-hour comprehensive nursing care
– Is not medically stable
Someone is also not allowed to live in assisted living if two of these three issues are applicable: He or she needs total assistance with eating, toileting, or moving from room to room.
An evaluation of the patient’s needs is required before admission, and must be updated semi-annually. The evaluation must include:
– Physical, cognitive, and mental status
– Ability to perform ADLs
– The resident’s weight
– Ability to self-administer medications
The contract between a resident and the residence in Indiana must include the home’s licensure status, services provided, and information on costs and charges. Residential care facilities must file a disclosure agreement annually with the state’s Division of Aging, and this agreement must also be provided to residents or people who are considering moving in. In memory care, residents receive standardized forms with information including how an assessment is made, how special care plans are implemented, a description of activities provided, and the number of staff and staff training requirements (see above).
Bedrooms (or “resident units”) must be at least 100 square feet for one person, and at least 80 square feet per person if there are multiple occupants. The maximum number of beds allowed in a resident unit is four. Every unit must have a toilet, sink, and bathtub or shower. Regulations are not specific about fire safety and locks, except to say residences must be surveyed and up to code.
There are no specific staff-to-resident ratios in assisted living in Indiana. Rather, staffing must be adequate to address the health needs of every resident, and someone certified to perform CPR must be on-site and awake at all times.
Training depends on the types of residents. Staff who work directly with people who have dementia must have at least six hours of dementia-specific training within six months of hiring, and then three more hours of training annually. Administrators must have work experience that specifically relates to dementia-friendly memory care.
Administrators must be licensed, a process which includes a training program that is at least 860 hours (though a waiver may be granted by the state for qualified applicants). Administrators must also have 40 more hours of semi-annual continuing education in a relevant field.
This financial assistance from the Indiana Medicaid program is designed to help people who may need nursing-home level care stay in their own houses or assisted living communities. It can also help someone who wants to move out of full-time nursing care into assisted living. Applicants who meet Indiana’s Medicaid eligibility guidelines (including monthly income under $2,313 in 2019) receive help to cover home and community-based services (HCBS), including case management, assisted living, nutritional supplements, and transportation. Enrollment is limited, so there may be a waiting list.
This program does not fall under Medicaid, though recipients must meet similar qualifications, including monthly income under $2,313 in 2019. People who live in (or are moving into) residential care facilities that have an approved RCAP contract may receive money to cover boarding costs, as well as food, care coordination, and more. Not all Indiana memory care homes are RCAP eligible. For more information, click here.
Veterans are statistically more likely to develop dementia. Relevant in all states including Indiana is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is an amount of money added to veterans’ and survivors’ basic pension. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these pensions can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive as much as $14,761. Learn more here.
There are also Veterans homes in Indiana, 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. State veterans homes are typically reserved for veterans whose need for care stems at least 70 percent from their military service. Because there is often a waiting list, contact a home before visiting to see if your loved one is eligible to live there.
Other ways to help pay for assisted living with memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that may include some assisted living costs.
A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should their spouse move from their home, the reverse mortgage would become due.
Elder care loans are for families to cover initial costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.