Massachusetts Residential Alzheimer’s Care (Memory Care): Rules, Costs & Financial Help

Legal Definition of Assisted Living / Memory Care in Massachusetts

Assisted living residences in Massachusetts offer housing, meals, security and personal care for adults who need help with activities of daily living like housekeeping and dressing. For people with Alzheimer’s disease or dementia, there are special care residences. Known as memory care, these units can be an entire community or a special wing of assisted living.

Every memory care residence is required to provide a philosophy and mission statement that shares its goals for supporting residents. These mission statements can be generic, often stating that the community is “committed to fulfilling the needs of residents”.  They’re part of a longer, more specific list of disclosure items you’ll want to ask for when considering a memory care community. The list will tell you about services, activities, and policies at the residence, as well as costs, meals, and how visits are handled.

Memory care staff must have additional training in serving the needs of people with dementia. Other requirements specific to special care residences include a secure outdoor area for residents who may be prone to wandering.

Assisted living in Massachusetts is regulated by the state’s Executive Office of Elder Affairs. There are approximately 180 memory care homes in the state. There are also 10 board and care homes, which offer the same services as assisted living, often including memory care. These are a house-like setting for 12 or fewer residents. For free help finding a memory care home to meet your family’s needs and budget, click here.

How Much Does Memory Care Cost in Massachusetts?

The average cost of memory care per month in 2024 in Massachusetts is $8,518. Massachusetts has higher costs compared to other states; the 2024 national average is $5,884 per month.

The state’s most populated city is Boston, where memory care costs $8,905 monthly. Massachusetts’ most expensive memory care is in Barnstable Town costing $9,143 monthly. The least expensive city for memory care is Pittsfield, running $2,743 per month. Memory care is generally less pricey in the western (Berkshires) part of Massachusetts, in towns including Pittsfield, Lenox, and Stockbridge.

You might consider looking outside the state when looking for a memory care home for your loved one. Across the state border, in New York, memory care is also generally less expensive than in Massachusetts. The statewide average monthly price of memory care in New York is $6,003. It costs $6,877 in Albany and $5,884 monthly in Kingston, which are within an hour’s drive. Rhode Island averages $8,905 and Connecticut runs $6,719 per month.

Massachusetts Assisted Living Laws & Regulations

Admissions Process & Requirements

Before moving in, a resident must be assessed by a nurse who works for the residence. The price of this assessment is usually covered by a community fee that also includes move-in costs like deep cleaning the new resident’s room. The assessment determines:

– Patient’s needs and preferences
– The resident’s ability to perform activities of daily living
– The resident’s cognitive status (stage of dementia) and its how it impacts on functional abilities
– Whether the resident can self-administer medication

All this information goes into an individualized service plan. This details medications, allergies, dietary needs, and a behavioral history. There is no time frame during which the assessment must be completed but families should expect this to occur within the few first weeks of a move.  A diagnosis of dementia is not required to move into memory care in Massachusetts. Dementia is difficult to diagnose as symptoms change over time.

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 activities of daily living
– 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

Someone who needs full-time nursing care may not be admitted into assisted living in Massachusetts, unless the care is provided by someone certified to work within the residence.

It is possible to find a memory care home on short notice, but this is not a good idea. The sooner you begin searching, the more input your loved one can provide and the more likely you are to find a perfect fit.

Facility / Residence

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. Every living unit or bedroom must have its own toilet, sink, and bathtub or shower.

Memory care units must provide a secure outdoor area, where residents can walk safely. Regulations do not specify other rules about how the facilities should be physically designed. Looking for design features that are dementia-friendly when touring a potential home for your loved one is important to keep in mind. These would include easily navigated spaces, hallways that run circular so people with dementia avoid dead ends, and softer paint colors.

Staff & Training

There are no required 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 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 activities of daily living. All memory care staff must receive two hours of training annually on assisting people who have Alzheimer’s or a related dementia.

Evictions & Discharges

The documents that are provided by the home to anyone moving in include an explanation of what would cause a facility to decide to evict a resident. Regulations are not specific about what can get a resident evicted, so the community is able to determine that for itself. Grounds for eviction or discharge usually include nonpayment, aggressive or dangerous behavior, damage to property, or a medical condition that cannot be safely treated there. Memory care homes can make their own eviction policies but they must tell you about them before you move in.

It’s important to be clear on the eviction policy, and to get the specifics in writing. Unfair evictions are a problem in assisted living, and having your own document that covers this issue will help protect against an unexpected notice of eviction.

If you do receive an eviction notice, there are steps you can take in the process of fighting the decision or finding a new home. For more on what to do next, click here.

Financial Assistance For Residential Alzheimer’s Memory Care

MassHealth Personal Care Attendant

Medicaid is a jointly funded federal and state program, and in Massachusetts, MassHealth provides long-term care and support. The Personal Care Attendant program (PAC) is meant to keep people with acute medical needs out of nursing home care, enabling them to remain in their own houses or assisted living. Benefits have a set budget and are determined by an individual’s need and on a case-by-case basis. Benefits can range from assistance with activities of daily living to medication administration, and transportation. Eligibility requirements include financial criteria and medical needs. In 2024 this includes not earning more than 133% above the Federal Poverty Level which is $1,669 and countable assets less than $2,000. Enrollees must demonstrate a need for extra support services by needing assistance with two or more activities of daily living. For more information, click here. To apply, click here for an application for Health Coverage for Seniors and People Needing Long-Term Care Services. For a Medicaid eligibility test click here and for more information about Massachusetts Medicaid Eligibility requirements click here.

Group Adult Foster Care Program

The Group Adult Foster Care Program (GAFC) helps low-income Massachusetts residents with the cost of group adult foster care, which can include assisted living if the program has been approved by the residence. Adult foster care homes are smaller group homes. The program offers benefits that can cover long-term care services such as assistance with activities of daily living, light housekeeping, and medication management but cannot pay for living costs like room and board. The Supplemental Security Income Assisted Living Benefit (SSI-G), however, does cover room and board and can be combined with group adult foster care program benefits. To be eligible for this program one must meet strict financial requirements and demonstrate a medical need. As of 2024, one’s monthly income can not exceed 100% of the Federal Poverty Level which is $1,255, or have countable assets valued at more than $2,000. Enrollees must demonstrate that they need assistance with one activity of daily living. For more information, call the MassHealth Customer Service Center at (800) 841-2900 or one’s local Aging Services Access Point (ASAP) office. To apply, click here for an application for Health Coverage for Seniors and People Needing Long-Term Care Services.

Frail Elder Home & Community-Based Services Waiver

Frail Elder Home & Community-Based Services Waiver (FEW) is a state-run Medicaid program designed to help individuals live independently in their community and not need to move into a nursing home. Benefits extend to those living in their own home, that of a loved one, or an adult foster care home (not in assisted living or memory care). Benefits are based on an individual’s need and can include respite care, assistance with activities of daily living, transportation, home modifications, assistive technology devices, meal delivery, and assistance with household chores. FEW eligibility requirements in 2024 include income less than $2,829 and countable assets less than $2,000. Additionally, enrollees must demonstrate a medical need and require a nursing home level of care. More information is available on the program’s website by clicking here. To apply click here for an application for Health Coverage for Seniors and People Needing Long-Term Care Services or contact your local Aging Services Access Point (ASAP). For a Medicaid eligibility test click here and for more information about Massachusetts Medicaid Eligibility requirements click here.

Adult Day Health Care

Adult Day Health Care (ADH) is a program that offers long-term care benefits in the form of adult day care to qualified applicants. This program is meant to offer extra supportive services enabling one to live independently and not need to move into a nursing home. ADH allows enrollees to live in their own home, that of a loved one, in adult foster care, or assisted living (so long they are not receiving MassHealth benefits from another program). Benefits can include respite care, case management, dementia care, assistance with activities of daily living, skilled nursing, and transportation. Eligibility requirements for ADH include monthly income less than $1,255 in 2024 and countable assets less than $2,000. Enrollees must demonstrate a medical need for additional care services. For more information call the MassHealth Customer Service Center at (800) 841-2900 or one’s local Aging Services Access Point (ASAP) office. To apply, click here for an application for Health Coverage for Seniors and People Needing Long-Term Care Services. For a Medicaid eligibility test click here and for more information about Massachusetts Medicaid Eligibility requirements click here.

Enhanced Adult Fostercare/Caregiver Homes Program

The Enhanced Adult Fostercare/Caregiver Homes Program (AFC) is meant to assist those who need extra long-term supportive care services to stay in their community. Care benefits are afforded to those who live in private homes but will not pay the cost of room and board. Care benefits can include supervision, assistance with activities of daily living, medication management, transportation, housekeeping, and caregiver training. To qualify for AFC, there are limits on one’s monthly income and a medical need. In 2024, the AFC eligibility requirements include monthly income less than $1,255, countable assets less than $2,000, and assistance with one or more activities of daily living. For more information, call the MassHealth Customer Service Center at (800) 841-2900. To apply, click here for an application for Health Coverage for Seniors and People Needing Long-Term Care Services. For a Medicaid eligibility test click here and for more information about Massachusetts Medicaid Eligibility requirements click here.

Supplemental Security Income Assisted Living Benefit

This benefit is from the Social Security Administration and provides up to $1,397 in 2024 for eligible residents to help pay for room and board in assisted living and special care residences as MassHealth is prohibited by law from doing so. Apply through your nearest Social Security office.

Veterans Affairs (VA)

Veterans are statistically more likely to develop dementia. Among the reasons for this is that traumatic brain injuries and posttraumatic stress disorder lead to a higher probability of developing the condition. The VA offers many benefits for Alzheimer’s and dementia as well as different pension types.

VA Pensions

There are three types of VA Pensions available. The benefits change annually and are valid from December 2023 to December 2024. The benefits (and their maximum allowance) are as follows:

1) Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses who are aged or disabled. The qualifying disability does not need to be related to their military service. On an annual basis, the Basic Pension pays:

– Veterans without spouses or children up to $16,551

– Veterans with dependent spouses or children up to $21,674

– Surviving spouses without dependent children up to $11,102

2) Aid & Attendance – Abbreviated as A&A, this is an important program for veterans and their surviving spouses who require assistance with activities of daily living. This means they need assistance with activities like bathing, dressing, and eating. A&A is particularly helpful for people with dementia, especially in the middle and later stages of the disease, when the need for more assistance becomes necessary. A&A is intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s need and the progression of the disease, most of these additional services that support your loved one will become necessary. Annually, the A&A pays:

– Veterans without spouses or children a maximum of $27,609

– Veterans with dependent spouses or children a maximum of $32,729

– Surviving spouses without dependent children a maximum of $17,743

3) Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes, making them require additional assistance. The definition of “home” can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover long-term care costs. Annually, the Housebound pays:

– Veterans without spouses or children a maximum of $20,226

– Veterans with dependent spouses or children a maximum of $25,348

– Surviving spouses without dependent children a maximum of $13,568

Veterans Homes

There are also two veterans’ homes in Massachusetts, called Soldiers Homes, which are residential care facilities that provide long-term care for veterans. They are located in Holyoke, in central Massachusetts near Springfield, and Chelsea, across the Mystic River from Boston. In addition to nursing home care, assisted living and memory care are provided. There are only 14 beds for memory care in the Soldiers Home in Chelsea and none in Holyoke. Neighboring states have more veterans’ homes, so a loved one might consider looking there for more options as there are no requirements that one must live in the state. For example, New York has five statewide and the other surrounding states (Connecticut, Rhode Island, Vermont and New Hampshire) all have one apiece. More info.

Other Options

1)Elder care loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.

2) 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 can include assisted living costs.

3) A reverse mortgage can be an option for a married person moving into memory care, if their spouse continues to live in the home. However, if the spouse moves from their home, the reverse mortgage becomes due.