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Indiana Residential Alzheimer’s Care (Memory Care): Laws, Costs & Financial Help

Last Updated: November 30, 2020

 

In Indiana regulations, assisted living homes are called “residential care facilities,” providing 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.

Some assisted living homes in Indiana have special programs or units for people with Alzheimer’s or a related disease including vascular, frontotemporal, and Lewy body dementias. There are about 160 memory care residences in Indiana. For free help finding a residence that meets your family’s needs and budget, click here.  These special care units (also called “Alzheimer’s care” or “memory care”) have additional requirements. A doctor’s diagnosis of dementia is not required to move into memory care in Indiana. Dementias including Alzheimer’s are difficult to diagnose, and symptoms can vary.

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
– How the home determines that a resident is suitable for memory care
– A process for assessment, and activation of a personalized 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.

 Did You Know? Only about 11% of people over 65 have Alzheimer’s disease in Indiana, one of the lowest rates in the country. The number of people there with Alzheimer’s is expected to be about 135,000 by 2025.

 

How Much Does Memory Care Cost in Indiana?

The average cost of memory care per month in Indiana is $4,910, which breaks down to about $58,920 annually. The state’s most expensive place for memory care is Muncie, running $6,790 per month and $81,480 annually. The least expensive is Bloomington, about an hour south of Indianapolis, for $3,560 per month and $42,720 annually. Indianapolis is by far Indiana’s biggest city, and memory care costs are about the same there as the state average of $4,910 monthly and $58,920 yearly. Fort Wayne, the state’s second-biggest city, costs about $4,360 monthly and $52,320 per year. Other cities and costs:

 Note: In Indiana, persons with dementia and their family members are entitled to free assistance finding memory care homes that meet their budget. Start here.

Indiana Memory Care / Assisted Living Costs (updated Nov. 2020)
Region / City Monthly Cost Annual Cost
Statewide $4,910 $58,920
Indianapolis $4,910 $58,920
Fort Wayne $4,360 $58,920
Evansville $4,540 $54,480
South Bend $5,090 $61,080
Bloomington $3,560 $42,720
Lafayette $5,380 $64,560

 

Indiana Assisted Living Laws & Regulations

Admissions Process & Requirements

An evaluation of the patient’s needs is required before admission into an assisted living residence, 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

This evaluation, or assessment, is often conducted by a healthcare professional working for the residence. Some assisted living homes will charge a “community” or “move-in” fee that includes up-front costs including the assessment and details like deep cleaning and painting the room to prepare for a new occupant. Other homes require the assessment to be conducted by an outside doctor, meaning your loved one will need to pay for it like any other medical appointment.

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 below).

It is possible to move into assisted living on short notice, but this is not a good idea because of the steps involved and because the sooner you begin looking for a home the more likely you are to find a perfect match. Beginning your search early also allows your loved one to contribute more to the decision, which gets difficult with the thinking problems that come in the middle and later stages of dementia.

Nursing care can be provided in assisted living, meaning residents can be treated for medical issues. The care must be intermittent, meaning not required 24 hours per day. Someone who needs nursing supervision beyond what a residence can provide is allowed to contract with outside doctors’ offices to receive that care. Rehabilitation therapies are also only allowed if a resident has an agreement with an outside (third-party) provider.

A resident cannot be admitted into assisted living 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 (help from more than one person) with eating, toileting, or moving from room to room.

 

Facility / Residence

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.

Memory care residences are not required by regulations to have dementia-friendly design features like easily navigated hallways that run circular, so residents won’t encounter dead ends. In some states, this is required. When considering an assisted living home, inspect it with an eye on whether your loved one will be comfortable in the space. Outside areas have also been shown to be beneficial for people with Alzheimer’s disease or related dementias, yet are also not required by Indiana regulations, unlike in other states.

 Covid 19-Related Rules for Residences
During the pandemic, Indiana assisted living homes may only allow indoor visits after 14 days without a positive test for the virus (staff and residents). All visitors must still wear masks and maintain six feet of social distancing.
For more on Covid 19 and visitations in Indiana, click here.

 

Staff & Training

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.

 Covid 19-Related Rules for Staff
During the pandemic, employees in Indiana assisted living homes are to be monitored daily for symptoms of Covid 19 (fever, cough, shortness of breath), and be trained on putting on and removing personal protective equipment like masks and gloves, as well as sanitization of surfaces.

 

Evictions

Indiana regulations say a person “must be discharged” for these reasons:

– Is dangerous to self or others
– Needs nursing care 24 hours per day
– Has a medical condition that cannot be managed by the residence
– Is medically unstable
– Cannot do two of these three things without total assistance: eat, go to the bathroom, move from room to room

“Total assistance” usually means it takes more than one person to help with a task.

No regulations say memory care can discharge or evict someone for nonpayment, but residences may have their own policies. It’s important to be very clear about exactly what can lead to an eviction. If you are considering assisted living or assisted living with memory care for your loved one, ask for this information in writing. For more on how to handle an eviction, click here.

 

Financial Assistance For Residential Alzheimer’s Memory Care

Indiana Aged and Disabled Medicaid Waiver

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 $2,382 in 2021) 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.

 Not sure if your loved one qualifies for Medicaid? Click here for a Medicaid “Eligibility Test”.

 

Residential Care Assistance Program (RCAP)

This program does not fall under Medicaid, though recipients must meet similar qualifications, including monthly income under $2,382 in 2021. 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 Affairs (VA)

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 (2021) maximum amount a veteran can receive through A&A is $27,540 per year, and surviving spouses can receive as much as $14,928. Learn more here.

There is also one veterans’ home in Indiana, in West Lafayette. The Indiana Veterans’ Home is a residential care facility that provides long-term care for veterans, including full-time nursing, short-term rehab, and memory care. 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 the home before visiting to see if your loved one is eligible to live there. For contact details and more information, click here.

 

Other Options

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.