The official term for memory care in Iowa is “Dementia-Specific Assisted Living Programs.” These residences provide personal and health-related care including assistance with activities of daily living (ADLs). Further, family engagement is encouraged, with tenants’ families empowered to be as involved as possible in making decisions about their own care.
Assisted living communities may only admit people with dementia after they’ve been inspected and approved by the Iowa Health Facilities Division’s Department of Inspections and Appeals. The department says it focuses most on staffing, services plans, design, and safety. Those service plans, which explain how people with dementia are cared for, must include planned and spontaneous activities based on a resident’s abilities and interests.
The average cost of memory care in 2020 in Iowa is $5,345 per month, which breaks down to about $134 per day and $64,140 annually. Iowa regulations say new residents must receive a full description of fees, charges, and rates, as well as all costs for additional and optional services. Assisted living, without the additional services required for memory care, costs Iowa residents about $4,084 per month and $49,008 annually.
The state’s most expensive places for memory care are Dubuque and Waterloo, where memory care costs are about $6,023 per month and $72,276 annually. Memory care is least expensive outside the 10 biggest cities, in rural areas where the average cost is about $4,347 per month and $52,164 annually. The largest city in Iowa is Des Moines, where memory care costs about $5,704 per month and $68,448 annually.
Within 30 days of moving in, every resident must be assessed for functional, cognitive, and health status. This assessment must be updated at least annually.
All assisted living homes in Iowa must provide documentation to potential residents that includes the following information:
– Description of all costs including potential additional charges
– Procedure for nonpayment
– The term of occupancy
– A promise to notify resident (or resident’s legal representative) in event of any change, at least 30 days prior
– Transfer or eviction criteria and process
– Procedure for filing a grievance
– Emergency response policy
– Summation of staff, including number of nurses
– Details of all programs that encourage activity and socialization for people with dementia
– Refund policy
Someone with the following issues may not be admitted into Iowa assisted living:
– Requires full-time health-related care
– Is bed-bound
– Is under 18 years old
– Requires two people to help with standing or going to the bathroom
– Has unmanageable chronic incontinence
– Is dangerous to self and others
– Has alcohol or drug addiction
More generally, no assisted living home can admit someone whose care needs cannot be fulfilled there.
A single-occupancy room (or living unit) must be at least 190 square feet. Double-occupancy rooms must be at least 290 square feet. These sizes exclude bathrooms, and every living unit needs a toilet, sink, and bath or shower. Two people is the maximum allowed in a living unit. In memory care, all exit doors must be equipped with alarms, to notify staff in case of a resident wandering outside.
There are no staff-to-resident ratios in Iowa, except to say that staffing must at all times be adequate to meet the needs of every single resident. Someone must be on duty 24 hours per day. All assisted living communities must be overseen by a registered nurse.
Administrators must have six hours of training on Iowa assisted living laws. For all other staff, training must include, at a minimum, how to assist with activities of daily living and instrumental activities of daily living. Anyone working with residents with dementia must have at least eight hours of dementia-specific training within 30 days of hiring, and then annually.
Iowa’s Home and Community Based Services waiver is a Medicaid waiver that helps cover costs including care within assisted living. It is designed to help people who need extensive medical care remain in their own homes or assisted living communities, rather than transferring to a more expensive nursing home. The waiver includes a Consumer Choices Option (CCO) and Consumer Direct Attendant Care (CDAC), though CDAC is probably more relevant to people living in their own houses. The waiver provides flexibility to shop for services that help with issues like transportation and assistance with ADLs. CCO, for example, sets a budget and allows freedom to find services within that budget. Medicaid cannot cover costs of room and board, but other needs including medical devices may be covered. Applicants should know there may be a waiting list. Read more about Iowa Medicaid eligibility guidelines for 2020 or take an eligibility test.
Veterans are statistically more likely to develop dementia. Relevant in all states including Iowa 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 pensions. 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 Iowa, 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 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 the 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.