The types of residences in Maryland that can offer full-time care and services to people with Alzheimer’s disease, or a related dementia, are called “assisted living facilities” with an “Alzheimer’s special care unit.” Another common term for these is “memory care.” Broadly, residents in assisted living are given housing, supervision, support, and health-related services including help with activities of daily living (ADLs) like eating and dressing.
State regulations on memory care homes are not very specific about how much more care must be provided, but any assisted living residence housing people with dementia must submit the following to the Office of Health Care Quality, which regulates assisted living under the banner of the Maryland Department of Health:
– Description of the unit (memory care facilities are typically built with special considerations, including secure outdoor areas and special locks on bedroom units)
– Statement of philosophy or mission
– Staff training and titles (see below)
– All procedures that go beyond the treatment provided in normal assisted living
Assisted living facilities in Maryland offer three designations of care: low, moderate, or high. Someone in the late stages of Alzheimer’s will obviously need to live in a high-level residence, while a person in the early or middle stages will live in low or moderate. An important note, however, is that assisted living may not legally house someone whose health needs cannot be met there. Because Alzheimer’s is progressive, your loved one in low or moderate memory care will eventually need to move somewhere offering more care, like a high-level residence or a nursing home. More on managing and preventing evictions from memory care.
The average cost of memory care per month in Maryland in 2019 is $5,624, which breaks down to about $185 per day and $67,488 annually. Assisted living, without the additional services required for memory care, costs Marylanders about $4,298 per month and $51,576 annually.
The state’s most expensive place for memory care is California (in St. Mary’s County), where memory care costs about $8,216 per month and $98,592 annually. The least expensive city for memory care is Cumberland, for about $4,906 per month and $58,872 per year. In Baltimore, the state’s biggest city, memory care costs about $5,544 per month and $66,528 annually.
Within 30 days before admission, a resident must be assessed using the Residential Assessment Tool to gauge health, function, and psychosocial status (which is like emotional and social well-being). This assessment is provided by the residence into which they hope to move. Based on the results, the memory care home will create a resident’s service plan that outlines what your loved one needs and how those needs will be met.
Assisted living homes in Maryland may not admit someone with any of the issues listed below. However, this is not a hard rule as a home may request a waiver specific to a resident who has one of the above conditions or issues and therefore they may be allowed to move in.
– Requires full-time nursing care
– Stage III or IV skin ulcers
– Requires a ventilator
– An acute and fluctuating medical condition that requires monitoring and frequent medication and treatment changes
– Illness that requires isolation from other residents
– Presents a danger to self or others
Bedroom units must have at least 80 square feet of space for a single-person room, and 120 square feet per person if there are multiple occupants. The most people allowed in one bedroom is two. That space does not include the closet or bathroom. There also must be one toilet for every four residents and one shower or bathtub for every eight. Smoke detectors are required in every bedroom and outside the rooms within their vicinity. A plan for fire evacuation must be posted on every floor, and fire drills are required four times per year.
There are no staff-to-resident ratio requirements in Maryland, though regulations say staffing must at all times be adequate to serve the needs of every resident. Assisted living communities in Maryland must have a contract with a registered nurse who may or may not be directly employed there. Managers must be at least 21 years old, with a high school diploma (or equivalent) and sufficient training to fulfill the role of running an assisted living community. For a community offering high-level care, the manager must have a four-year college degree, two years’ experience in health care, and at least one year of experience in assisted living. An 80-hour assisted living training program must also be completed.
Staff who aren’t managers must be at least 18 years old, and must complete five hours of training on cognitive impairment and mental illness within 90 days of starting work. An orientation and ongoing training are also required.
Services for someone in memory care in Maryland may be covered with funds from the Community Options Waiver. This waiver is for people who fulfill Medicaid requirements, including monthly income below $2,349 in 2020, and stay in a moderate- or high-level assisted living facility (see above). The idea behind it is that someone who needs expensive nursing-home level care can actually stay in their house or memory care community, and use Medicaid funds to cover intermittent nursing care and things like nutritional services, case management, and behavioral counseling. The program is popular in Maryland, so there may be a waiting list; depending which part of Maryland you live in, enrollment could take years. To apply, contact your local Area Agency on Aging.
ICS is for people in nursing homes who want to transition back to their own houses or into assisted living. Services covered for Medicaid-eligible Marylanders include help with ADLs, which is part of living in memory care. The benefits are similar, in fact, to the Community Options Waiver (above) but the income requirements are different. ICS is available for people who have a higher level of income, so long as their monthly income does not exceed the cost of care. To apply, contact the Maryland Department of Health at 410-767-1739.
This is another Medicaid program designed to keep people who need nursing-home-level care out of a nursing home and in their own houses or assisted living. Community First Choice also has the added bonus of applicants never going on a waiting list, so meeting eligibility requirements (including requiring assistance with two ADLs and monthly income under $2,349 in 2020) should get someone quickly enrolled. Services covered include help with ADLs. Apply through the state’s Medicaid program. A slightly outdated fact sheet is available here.
This program provides money to recipients expressly for the purpose of covering the costs of assisted living. The income requirements are different than Medicaid’s (a person’s monthly income cannot exceed 60 percent of the state’s median). This program is not available in some Maryland counties, and there may be a waiting list. For more information, visit the Department of Aging website. To apply, contact your local Area Agency on Aging.
Veterans are statistically more likely to develop dementia. Relevant in all states including Maryland 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 Maryland, 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 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.