According to regulations, memory care for your loved one with dementia can be provided by two types of non-nursing home residences in Michigan: 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 provide supervision and personal care. Regulations state that AFCs are for people who are aged, mentally ill, and developmentally or physically disabled. AFCs are required by regulations to offer more specific services, including medication administration, social activities, and assistance with activities of daily living (ADLs). These services may also be provided at HFAs, and probably should be, 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 about the needs of residents with dementia
– The process for acceptance into, or transfer out of, their program for residents with dementia
– Explanation of how a resident is assessed – Explanation of how the assessment is used to create and implement an individualized care plan
– 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.)
Assisted living in Michigan is regulated by the Department of Licensing and Regulatory Affairs. There are 380 memory care communities in the state. There are also more than 1,000 board and care homes, which offer the same services as assisted living, including memory care in some cases, in a smaller, more house-like setting with fewer than 12 residents. Free assistance is also available to help families chose among these many options.
The average cost of memory care per month in Michigan is $4,800, which breaks down to about $57,600 annually.
The most expensive place for memory care in Michigan is Monroe, located on Lake Erie, for about $6,320 per month and $75,840 annually. The least expensive is Jackson, for $3,600 per month and $43,200 annually. In Detroit, by far Michigan’s most populated city, and including the huge suburbs of Warren and Sterling Heights, memory care costs about $5,520 per month and $66,240 annually. Michigan’s second-largest city is Grand Rapids, where memory care runs about $5,050 per month and $60,600 annually. In the Upper Peninsula, memory care is generally less expensive, averaging less than $4,000 per month.
Michigan is in the top 10 for least expensive assisted living costs. Memory care there is less expensive on-average than neighbors Ohio ($5,200 per month), Indiana ($4,910), and Wisconsin ($5,200). That said, it is still possible that residents of Michigan might find more affordable memory care outside the state because costs can vary widely. Other cities and their costs:
|Michigan Memory Care / Assisted Living Costs (updated Jan. 2021)|
|Region / City||Monthly Cost||Annual Cost|
To enter an HFA, a written statement from a residents’ doctor about specific health care needs is required. AFC guidelines are even stricter, requiring 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. Bottom line: When considering memory care for your loved one in Michigan, begin the process as soon as possible by speaking with a primary care doctor about what appointments and documents are required. The cost of these visits, before the residence assessment described in the next paragraph, will probably need to be covered by your loved one, but help with the costs might be available (see Financial Assistance below).
An individual assessment and service plan is required for every resident upon moving into either HFAs or AFCs. The assessment is conducted by a health professional working for the memory care community. The cost of the assessment is usually covered by an assessment fee paid during the move-in process, or by a “community fee” that covers other up-front costs (like paint and deep cleaning) and generally runs between $1,500 and $2,500.
Service plans describe your loved one’s unique care needs for physical and mental health, and must be updated by qualified residence staff 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 must not admit someone it cannot adequately care for.
A diagnosis of Alzheimer’s, or related dementia including vascular, frontotemporal, and Lewy body dementia, is not required for admittance into memory care in Michigan. Dementia is difficult to diagnose as symptoms change over time, and it’s important to find a community that serves people as individuals with unique symptoms rather than any specific disease.
Also, while it is possible to find memory care on short notice, this is not a good idea. You want to begin looking for a community before the move is necessary; the person with dementia can offer more input the sooner a search begins, and every residence is different so you’re more likely to find the right fit the more homes you investigate.
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 with design features appropriate for people with dementia who may, for instance, be prone to wandering or becoming very confused. An explanation of these design features 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, CPR, 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.
An assisted living home in Michigan is required to give a resident 30 days notice before discharge or eviction. Unlike other states, Michigan regulations do not require the home to help find your loved one a new residence. A person may be asked to leave assisted living, including memory care, for these reasons:
– Medical condition that cannot be treated at the residence
– Represents a danger to self and others
– Destruction of property
Unfair evictions is a major problem in assisted living. For information on what steps to take if you receive a notice of eviction from assisted living, click here.
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 $2,382 in 2021.
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. To find the office in your area with information including how to apply, click here.
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 (2021) maximum amount a veteran can receive through A&A is $27,540 per year, and surviving spouses can receive as much as $14,928. Learn more here.
There are also two veterans’ homes in Michigan, which are residential care facilities that provide long-term care for veterans. They are the Grand Rapids Home for Veterans and the D.J. Jacobetti Home for Veterans (in the Upper Peninsula). In addition to nursing home care, assisted living and memory care are provided. There are 70 beds in the Grand Rapids VA memory care unit and 26 beds in the D.J. Jacobetti memory care unit. 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. Contacts and applications are available at this link.
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.