“Assisted living facilities” in Montana provide health and personal care in a residential, or apartment-style, setting. Supervision and security is required 24 hours per day, and these communities must provide activities for residents. The types of these residences in Montana are Category A, B, and C. All three must provide housing with laundry, housekeeping, recreational activities, and help with activities of daily living (ADLs) like eating and dressing. Category A homes are for people who can live relatively independently; Category B is for residents who need full-time nursing care; and Category C is for people with “severe cognitive impairment” (problems thinking), which include Alzheimer’s disease and related dementias. Category C homes, therefore, would be considered memory care, with additional requirements including dementia-specific training for staff and appropriate design features like quiet areas with minimal distractions. For more on staff and facilities, see below.
Montana assisted living homes are regulated by the Department of Public Health and Human Services’ Quality Assurance Division.
The average cost of assisted living with memory care in Montana is $5,026 per month, which breaks down to about $165 per day and $60,312 annually. Assisted living, without the additional services required for memory care, costs Montanans about $3,840 per month and $46,080 annually. A list of all costs and fees should be provided by any residence to people interested in moving in.
In the state’s largest city, Billings, the average cost of memory care is $5,704 per month and $68,448 annually. The most expensive memory care in the state is in Missoula, where it costs about $6,421 per month and $77,052 annually. The least expensive place for memory care is outside its cities in rural areas, for about $4,866 per month and $58,392 annually, although in Montana, options in rural areas are limited.
Someone in the early stages of Alzheimer’s disease or another dementia could move into a Category A or B residence if the disease does not cause disruptive behavior and they require help with less than four activities of daily living (ADLs). Eventually, however, a Category C home will become necessary. A medical assessment is required before moving into any assisted living residence. Thinking ability, the ability to perform ADLs, and mood and personality assessments must be part of this. To move into a Category C assisted living home (also called memory care), a resident must:
– have a severe cognitive impairment that prevents expressing needs or making basic care decisions.
– be a risk to wander away from the residence.
– not pose a danger to self or others.
– not require restraints or confinement.
– have a written doctor’s order to move into Category C living.
In Category C residences, the following must be made available in writing to anyone considering moving in:
– Overall philosophy and mission of caring for people with dementia
– Processes for move-in, transfer, and discharge
– Process for move-in assessment
– Explanation for how to update health-care plan
– Staff training and education
– Physical environment and design features that are appropriate for people with cognitive impairment
– Level of involvement allowed for families
– Any costs of care or fees
Someone with these issues may not move into memory care in Montana, or may be evicted:
– Needs cannot be met there
– Presents a threat to self or others
– Cannot respond to verbal instruction
– Has a complex medical condition that cannot be treated there
– Fails to pay within a reasonable amount of time after appropriate notice
Residents’ living units must be at least 100 square feet for one person, and 80 square feet per person if there are roommates. Four people is the maximum allowed in one living unit. These sizes do not include bathrooms or closets. There must be one toilet for every four residents, and a shower for every 12. The physical environment or design must be appropriate for people with dementia. This usually means a simple layout with clear sight lines and landmarks that make it easy to navigate, quiet rooms with minimal distractions, and special locks to prevent wandering.
A licensed administrator with state-approved education and work experience must be employed at every Montana assisted living residence. Sixteen hours of continuing education annually are required for administrators, and in category C residences (memory care), eight hours of this annual training must be dementia-specific. The administrator is responsible for all operations. There is no required staff-to-resident ratio in Montana. An employee with CPR training must be awake and on-duty at all times. All staff receive training relevant to the needs established in residents’ service plans, and in category C residences this includes:
– Helping residents who cannot perform ADLs
– Techniques for minimizing dementia-specific behaviors including wandering, hallucinations, and delusions
– Therapies to promote social and emotional stimulation
– Encouraging dignity, independence, privacy and choice
– Managing medications
– Strategies for managing incontinence
Montana’s Big Sky waiver is a Home and Community Based Services (HCBS) waiver under the state’s Medicaid program that can help cover costs in assisted living. Funds through Big Sky cannot pay for room and board, but the costs of care in assisted living (personal care assistance, counseling, therapies, laundry, food, etc.) may be covered. Transportation and medical equipment is also covered. People receiving this benefit must be Medicaid-eligible. Requirements include monthly income under $783 per month for a single individual ($1,566 for a couple). Medicaid Planning professionals may be able to help get benefits for needy people who aren’t quite eligible. For more information, click here.
Veterans are statistically more likely to develop dementia. Relevant in all states including Montana is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is 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 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 $14,761. Learn more here.
There are also two veterans’ homes in Montana located in Columbia Falls and Glendive. These are facilities providing long-term residential 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 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 claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that might 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, the reverse mortgage would become due.
Elder care loans are for families to cover 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.