In regulations, the types of residences in Missouri that offer memory care, a full-time home with services for people with Alzheimer’s disease or related dementia, are called “assisted living facilities” or “residential care facilities.” Memory care may be an entire residence or 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 is different from regular assisted living. 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, these are the differences between assisted living and residential care in Missouri:
– People in residential care must be able to evacuate without assistance.
– Assisted living must build its care services around a social model.
– Assisted living must have a physician on duty who can supervise residents’ care.
– Assisted living is 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, while residential care facilities make more sense for someone in the early stages.
Memory care residences are regulated by the Missouri Department of Health and Senior Services. There are roughly 300 memory care homes in Missouri. There are also almost 200 board-and-care homes, which offer the same services as assisted living (often including memory care) in a smaller house-like setting for 12 or fewer people.
Did You Know? Missourians can receive free assistance locating memory care homes to meet their needs and budgets. Get help here.
The average cost of memory care per month in Missouri is $3,450, which breaks down to about $41,400 annually. This is one of the most affordable rates in the U.S., and well below the national average of about $5,000 per month.
In Kansas City, memory care costs are about the state average of $3,450 per month and $41,400 per year. Those average costs encompass that whole area, including Independence and Lee’s Summit. St. Louis is the most expensive place in Missouri for memory care, at $4,580 monthly and $54,960 annually. Outside its major cities, Missouri is one of the less expensive states for memory care, as its rural areas cost an average of $2,730 per month and $32,760 annually. There is not a big cost difference between the Ozarks and Prairie regions of the state.
Neighboring Kansas’s average costs are much higher, at $5,340 per month. Prices obviously vary widely, and anyone who lives in southern Missouri might consider looking in Arkansas, another of the more affordable states for memory care at about $3,780 per month. Other Missouri cities with costs:
|Missouri Memory Care / Assisted Living Costs (updated Jan. 2021)|
|Region / City||Monthly Cost||Annual Cost|
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 within 10 days of moving in. These assessments are conducted by a doctor working for the residence, and the cost of assessing is typically included in a “community fee” at the time of move-in. Community fees cover the assessments and other up-front costs like painting a new resident’s room, and generally run between $1,500 and $2,500.
Someone does not need a diagnosis of dementia to move into memory care in Missouri. Dementias are difficult to diagnose, with varying symptoms that change over time. It’s much more important to match your loved one with the home that fits their unique needs, rather than a home that specializes in a specific disease.
It is possible to move into memory care on short notice in Missouri, but this is not a good idea. Finding the right home is a process that includes inspections, asking questions of residents and staff, and weighing as many options as possible. You’ll want to take your time. Also, the person with dementia can have more say over where they end up if you start looking for a memory care home before the move is necessary.
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.
Thirty days notice is required before a resident in Missouri assisted living can be evicted or discharged, though exceptions to this rule are possible if a resident is considered dangerous. The reason for the eviction/discharge must be documented in detail. Generally, these are the reasons a person can be kicked out of memory care, according to Missouri regulations:
– The resident’s health or personal needs cannot be met at the residence
– The resident no longer needs the services there (unlikely for someone with dementia)
– The resident poses a danger to other residents
– Non-payment after “appropriate notice and reasonable efforts”
Before moving into an assisted living community, you’ll want to ask for a specific definition of “appropriate notice and reasonable efforts,” because it will vary depending on the place. Can they kick someone out for payment that’s a week or two late? Get the answer in writing, because unfair evictions are a big problem in memory care. For more on what to do next if you receive an eviction notice, click here.
Financial assistance for memory care 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 $904 in 2021. To apply, contact your local Missouri Department of Social Services. If you’re not sure if your loved one qualifies for MO HealthNet (Medicaid), click here for eligibility requirements, or take a fast and simple Medicaid Eligibility Test.
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. A&A is also called the “Enhanced Monthly Benefit” and the “Income Improvement 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 seven veterans’ homes in Missouri, which are residential care facilities that provide long-term care for veterans. These are located in Mexico, just north of Columbia and Jefferson City; Girardeau, along the big river in the Lowlands; St. Louis; Cameron, less than an hour north of Kansas City; Warrensburg, an hour east of Kansas City; Mt. Vernon, in the southwest; and St. James, an hour-and-a-half west of St. Louis in Phelps County. In addition to nursing home care, each home has a secured dementia unit with a dining room, activity area, and enclosed courtyard. 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. More information and contacts 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 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.