The types of residences in Missouri that offer memory care, a full-time home with supervision and care services for people with Alzheimer’s disease or another dementia, are either “assisted living facilities” or “residential care facilities.” State regulations say these types of communities may offer memory care as a special, secure wing of their community.
While assisted living and residential care must provide full-time security, supervision, and meals, their special care units for people with dementia go further. Among the requirements for memory care in Missouri is a full written disclosure, to anyone considering becoming a resident, which explains how its special care unit differs from the rest of the residence. This disclosure must include:
– A philosophy and mission on fulfilling the needs of residents with dementia
– The process for assessment and establishment of a care plan
– Staff training
– Architectural design features appropriate for people with dementia
– The types and frequency of activities
– Family support programs and how families stay involved
– The costs of care and any additional fees
– Safety and security information
Very broadly, the difference between assisted living and residential care is that people in residential care must be able to evacuate without assistance. Additionally, assisted living must build its care services around a social model, and have a physician on duty who can supervise residents’ care. Assisted living is also required to provide help with activities of daily living (like cleaning, dressing, and going to the bathroom), while ADLs are not part of the required scope of care in residential care facilities. For these reasons, special care units (memory care) in assisted living facilities are better for someone in the later stages of Alzheimer’s than those in residential care facilities, which make more sense for someone in the early stages.
Memory care residences are regulated by the Missouri Department of Health and Senior Services.
The average cost of memory care per month in Missouri is $3,789, which breaks down to about $124 per day and $45,468 annually. Remember that all assisted living homes in the state must disclose their costs fully to residents, so there should be no surprises in billing. Assisted living, without the additional services required for memory care, costs Missourians about $2,896 per month and $34,752 annually.
In Kansas City, the state’s biggest city, memory care costs are about the state average of $3,789 per month and $45,468 per year. St. Louis is the most expensive place in Missouri for memory care, at $5,026 monthly and $60,312 annually. Outside its major cities, Missouri is one of the cheapest states for memory care, as its rural areas cost an average of $2,991 per month and $35,892 annually.
Someone with the following conditions cannot be admitted into an assisted living facility:
– Behavior threatening harm to self or others
– Requires physical or chemical restraints
– Requires skilled nursing care the residence cannot provide
– Requires more than one person to help with activities of daily living (except bathing and transferring)
– Is bed-bound
An assisted living resident must be able to exit the building unassisted in the event of an evacuation. Assisted living facilities must screen residents, to ensure an appropriate fit, before they can move in. Then multiple physical exams are required: Within five days a community-based assessment must be conducted (and then reviewed semi-annually), and someone admitted into a residential care facility must also have a physical examination by a doctor within 10 days of moving in.
Resident units, or bedrooms, in assisted living and residential care facilities must be at least 70 square feet per person, and the maximum number of people allowed per unit is four. One toilet and sink must be provided for every six residents, and one shower or tub for every 20. In memory care, the physical environment must be designed with consideration for the needs of people with dementia. This usually means spaces to wander without encountering a dead end, special locking mechanisms and other security features that won’t trap or harm someone who is disoriented, and a comfortable outdoor area.
Staff in Missouri memory care facilities must have at least three hours of dementia-specific training during orientation. A program of dementia-specific ongoing training must be instituted by all memory care facilities.
In assisted living, there must be one staff person for every 15 residents during the day, and one employee for every 20 residents at night. Regulations state that this ratio is the minimum, and communities must have enough staff on hand at all times to meet the needs of every resident. Residential care facilities have similar ratio requirements, though they must also have a licensed nurse on staff who works eight hours per week per every 30 residents. Facilities must have a licensed administrator who takes at least 40 hours of relevant training every two years.
Financial assistance for memory care costs is available through the MO HealthNet (Medicaid) program called Supplemental Nursing Care. This is a cash benefit to help people with significant health issues cover the price of assisted living. Payments vary depending on the type of residence; people in assisted living residences receive almost twice as much as those in residential care facilities. A facility does not need to be Medicaid certified for a resident there to receive this benefit. Among the eligibility requirements is a monthly income limit of $885. To apply, contact your local Missouri Department of Social Services.
Veterans are statistically more likely to develop dementia. Relevant in all states including Missouri 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 Missouri, 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 the 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.