Assisted living residences in Massachusetts offer a combination of housing, meals, security and personal care for adults who need help with activities of daily living like housekeeping and dressing, but do not require full-time nursing care. For people with Alzheimer’s disease or related dementia, there are special care residences, also called memory care, which can be an entire community or a special wing of assisted living.
Every special care residence is required to create a philosophy and mission statement that encapsulates its goals for helping residents and is made available for anyone considering living there. These mission statements may be somewhat generic, often stating that the community is “committed to fulfilling the needs or residents,” for example, but they’re part of a much longer, more specific list of disclosure items you’ll want to ask for when considering a memory care community (see Admissions Requirements below).
Staff at special care residences must have additional training to specifically serve the needs of people with dementia (see Staff below). Other requirements specific to special care residences include a secure outdoor area for residents who may be prone to wandering (see Facility below).
Assisted living in Massachusetts is regulated by the state’s Executive Office of Elder Affairs.
The average cost of memory care per month in Massachusetts is $7,379, which breaks down to about $242 per day and $88,548 annually. Remember that assisted living homes in Massachusetts are required to provide an explanation of charges beyond the agreed-upon base payment, so there should be no surprises in costs. Assisted living, without the additional services required for memory care, costs Massachusetts residents about $5,639 per month and $67,668 annually.
The state’s most expensive place for memory care is also its most populated: in Boston, memory care costs about $8,456 per month and $101,472 annually. The least expensive city for memory care is Pittsfield, for about $3,949 per month and $47,388 per year. Worcester, the state’s second-biggest city, costs about $7,379 per month and $88,548 annually.
Someone who needs full-time nursing care may not be admitted into assisted living in Massachusetts unless the care is provided by someone certified and approved to work within the residence.
Before moving in, a resident must be assessed by a nurse. The assessment determines:
– Personal needs and preferences, relative to the home’s ability to meet those needs
– The resident’s ability to perform activities of daily living (ADLs)
– The resident’s cognitive status (stage of dementia) and its impact on functional abilities
– Whether the resident can self-administer medication
This goes into a service plan, which also contains medications, allergies, dietary needs, and a history of socialization issues.
There is no required amount of time before moving in that this assessment must be completed, but it’s a good idea to begin the process quickly when selecting a memory care home, to help ensure you’ve picked the right one.
Before a residency agreement can be signed and any money can be paid, the following information must be provided in a disclosure statement:
– The number and type of units the residence operates
– The number of staff per shift
– A list of residents’ rights
– An explanation of any additional costs that may go beyond the base agreement
– Medication management policy
– Explanation of any limitations on services provided, including whether staff cannot help with certain ADLs
– Number and duties of nurses employed by the home
– Process for resident assessment prior to move-in
– Explanation of CPR policies (how many staff are qualified to perform CPR and under what circumstances)
– Explanation of eviction policies
– Explanation of physical design features
– Example of a service plan and explanation of reviews, revisions, and signatures required
– Explanation of types of diets available
– List of activities for residents
– Security policy
– Disaster and emergency preparedness plan
– Policy on family members’ participation at the residence
Unlike in other states, Massachusetts regulations do not require bedrooms to be a certain number of square feet. Regulations do state that single- or double-occupancy rooms must have lockable entry doors and either a kitchenette or access to an area for cooking. Two is the maximum number of people allowed in a bedroom unit in assisted living and assisted living with memory care. Every living unit or bedroom must have its own toilet, sink, and bathtub or shower. Special care residences (memory care) for people with Alzheimer’s disease or related dementia must provide a secure outdoor area, where residents can walk safely.
There are no staff-to-resident ratios in Massachusetts. Residences must be sufficiently staffed at all times, with at least two employees awake throughout the night. No one convicted of a felony related to theft or selling controlled substances may be employed at an assisted living facility in Massachusetts. Administrators must be at least 21 years old, with relevant experience. Five hours of training are required for managers, not including training related to assisting someone with dementia.
Seven hours of orientation is required for staff who prepare meals or work directly with residents, and 10 more hours of relevant training is required annually. Fifty-four hours of training are required for staff who help residents with ADLs. All memory care staff must receive two hours of training annually on assisting people who have Alzheimer’s or a related dementia.
Medicaid is a jointly funded federal and state program, and in Massachusetts the program that provides long-term care and support is called MassHealth. The Personal Care Attendant program is meant to keep people with acute medical needs out of nursing care, enabling them to remain in their own houses or in assisted living. Benefits are determined by need on a case-by-case basis, but a specific budget is set for enrollees, and can include shopping for essentials and transportation to doctor appointments. To receive this benefit, someone must meet the requirements for MassHealth, including countable income under $1,041 per month in 2019. Apply through the Personal Care Management Agency. Candidates must document the level and nature of personal care needed. For agencies and contact information, click here. For a non-binding Medicaid eligibility test, click here.
GAFC helps low-income Massachusetts residents with the cost of group adult foster care, which includes assisted living if the GAFC program has approved the residence. Adult foster care homes are like smaller group homes. GAFC can cover services and medication management, but cannot pay for living costs like room and board. (The Supplemental Security Income Assisted Living Benefit, however, does cover room and board and can be combined with GAFC benefits.) Money from GAFC is meant to pay for assistance with ADLs like eating and bathing. To apply, call 1-800-841-2900 or visit any Massachusetts Elder Care Agency office.
This benefit is administered through the Social Security Administration, and provides up to $1,000 for eligible residents to help pay for room and board, including in assisted living and special care residences. To apply, visit any Massachusetts Elder Care Agency office.
Veterans are statistically more likely to develop dementia. Relevant in all states including Massachusetts 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 Massachusetts, 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.