The two types of residences in Michigan which can provide memory care for your loved one are called Homes for the Aged (HFA) and Adult Foster Care (AFC). One difference between them is that HFA have a minimum age limit of 55. Both types of homes have at least 20 residents and provide supervision and personal care. Regulations state that AFCs are for people who are aged, mentally ill, and developmentally or physically disabled. The required services at AFCs are also more numerous in official regulations, as AFCs must provide medication administration, social activities, and assistance with activities of daily living (ADLs). These services may also be provided at HFAs, but are not required by law.
HFAs and AFCs offering memory care (also called Alzheimer’s care or dementia care) must have the following information available in writing for any potential resident or caregiver:
– A stated overall philosophy and mission reflecting the needs of residents with dementia
– The process and criteria for acceptance into, or transfer out of, their program for residents with dementia
– Explanation of how a resident is assessed and then an individualized care plan is created and implemented
– Staff training and education practices
– Environmental and design features appropriate for housing residents with dementia
– The frequency and types of activities for residents
– Explanation of any potential fees. (See below for more on costs.)
The average cost of memory care per month in Michigan is $5,265, which breaks down to about $173 per day and $63,180 annually. Regulations say all fees, including supplemental charges, should be spelled out in writing to Michigan memory care residents, so there should be no surprises. Assisted living, without the additional services required for memory care, costs Michigan residents about and $4,023 per month and $48,267 annually.
The most expensive place for memory care in Michigan is Monroe, running $6,940 per month and $83,280 annually. The least expensive is Jackson, for $3,949 per month and $47,388 annually. In Detroit, by far Michigan’s most populated city, memory care costs about $6,063 per month and $72,756 annually. Michigan’s second-largest city is Grand Rapids, where memory care runs about $5,544 per month and $66,528 annually.
An individual assessment and service plan is required for every resident upon moving into either HFAs or AFCs. Service plans must be updated annually or whenever there is a significant change in a resident’s health. Anyone who needs continuous nursing care provided by a licensed nursing home cannot move into HFAs or AFCs, and of course the residence admitting a person must have the ability to adequately care for that person. To enter an HFA, a written statement from a residents’ doctor about specific health care needs is required. Stricter admission guidelines for AFCs require a written assessment that includes the determination that the residence can offer adequate care and that the person appears compatible with others who live there.
HFA bedrooms must be at least 100 square feet. Rooms with multiple residents must have at least 80 square feet per person. A maximum of four people are allowed in one bedroom. There must be one bathroom for every eight people, and a bath or shower facility for every 15.
AFC bedrooms must be at least 65 square feet. The maximum allowed per bedroom is two. There must be one bathroom and shower or tub for every 10 residents.
Memory care residences falling under either category must be constructed in a manner consistent with best housing people with dementia who may, for instance, be prone to wandering or becoming very confused. An explanation of design features appropriate for housing people with dementia must be included as part of written information given to all residents and their caregivers.
Regulations in Michigan say both kinds of homes must have adequate staff who are awake and able to serve residents at all times. There is no mandated staffing ratio in HFAs, but AFCs must have at least one staffer with appropriate skills for every 12 residents. HFAs must name one person the “supervisor of resident care” for every shift. This supervisor is responsible for supervision and safety of residents, including in cases of emergency. Employees in both kinds of homes must have background checks, including fingerprinting to check for a criminal record. Administrators in HFAs must be at least 18 and have relevant education, training, and/or experience. In AFCs, administrators must have a high school diploma or GED and at least one year of experience working with the population identified in the home’s program statement and admission policy. An AFC administrator must also be trained (or demonstrably competent) in nutrition, first aid, PRC, the Adult Foster Care Act, fire safety, financial and administrative management, residents rights, and how to contain and prevent communicable disease.
For training, management of HFAs is required to establish training programs based on the home’s program statement and residents’ service plans. Training must also address employee issues like reporting requirements, first aid and medication administration, residents’ rights, and infectious disease containment. AFC regulations say staff must know how to meet the needs of all residents, and be competent in the following areas:
– Reporting requirements
– First aid
– Personal care
– Residents’ rights
– Safety and fire prevention
– Prevention and containment of communicable diseases
Anyone in either home who works with people who have dementia must be trained and competent to meet the specific needs of such residents.
Formerly referred to as the Home and Community Based Services for the Elderly and Disabled program (HCBS/ED), this waiver available through Medicaid is for seniors and disabled people who require nursing-home-level care but want to stay at home or in assisted living. It can also help transition from a nursing home into memory care. Participants must meet Michigan Medicaid eligibility guidelines, including monthly income of less than $2,313 in 2019.
Services for people accepted into the program are determined on a case-by-case basis, but can include personal care within an assisted living residence. It is important that eligible people with Alzheimer’s or related dementia apply for MI Choice as soon as possible, because there’s a waiting list and the process could take between six months and a year. The Michigan Department of Community Health’s Medical Services Administration runs the program.
Veterans are statistically more likely to develop dementia. Relevant in all states including Michigan 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 (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 Michigan, 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.