In Montana regulations, “assisted living facilities” 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 have activities for residents. The types of assisted living facilities 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
– 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. There are 25 memory care homes in Montana. Unlike most other states, Montana does not have board-and-care homes that offer the same services as memory care in a smaller, house-like setting (usually 12 people or less). It is possible, however, to find smaller memory care options. For free help finding memory care to meet your family’s needs and budget, click here.
The average cost of assisted living with memory care in Montana is $4,950 per month, which breaks down to about $59,400 annually. This puts Montana at about the national average of roughly $5,000 per month for memory care. In Billings, the average cost of memory care is $4,843 per month and $58,116 annually. The most expensive memory care in the state is outside the three biggest cities of Billings, Missoula, and Great Falls; in Montana’s more rural areas, memory care costs about $5,166 per month and $61,992 annually. Missoula’s average costs are $4,627 monthly and $55,524 annually. Great Falls’s average memory care costs run about $4,233 per month and $50,796 annually.
In a state as large and thinly populated as Montana, you may need to look in neighboring Idaho, Wyoming, or the Dakotas for memory care for your loved one. If you live in Missoula, for instance, or the surrounding glacier country, it might be possible to find more affordable memory care in Idaho, whose state average of $3,874 per month for memory care is among the country’s lowest. Wyoming and North Dakota, to the south and east, average about the same as Montana, at $4,914 and $4,843 per month respectively, but it still may be possible to find the right home for less money if you investigate options. Free assistance is available to help families find memory care regardless of the city or state in which they are located.
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. The assessment is usually conducted by a medical professional who works at the residence, and the cost of the assessment is often covered by a “community fee” that includes other up-front expenses like deep cleaning or painting a new resident’s room. Community fees typically cost between $1,500 and $2,500. (If a memory care community does not have someone to assess a person moving in, then a private doctor may need to complete this step at the resident’s expense, but this should be made clear well before a decision gets made to move in.)
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
A note from your loved one’s primary care doctor is required to move into memory care in Montana, but this is not the same as an official diagnosis. Someone does not necessarily need a diagnosis to enter memory care; Alzheimer’s and related diseases including frontotemporal, vascular, and Lewy body dementias are difficult to diagnose and distinguish because symptoms change and vary. It’s important to match a home to your loved one’s unique needs, not any specific disease.
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. Regulations do not specifically say that a secure outdoor space is required, but this is something to look for because being outside has been shown to benefit people with dementia.
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
Unlike other states, Montana does not have statewide regulations about evictions from assisted living. The rules say that a resident must be “transferred” if they cannot receive adequate care. No one, in other words, may stay at an assisted living home that is not equipped to handle their condition. For people with dementia, this would mean that as activities of daily living like eating and dressing get harder, staff must have adequate training to help your loved one stay as safe and healthy as possible.
One of the items required to be included in a written resident agreement is “criteria for transfer or discharge.” This means the home must explain, in writing, the reasons someone can be evicted. Be sure you understand this document and that it is as specific as possible, because unfair evictions are a big problem in memory care. File it in case the issue comes up later. For guidance on what to do next if you receive an eviction notice, click here.
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 in 2021 include monthly income under $794 per month for a single individual ($1,588 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. A&A is specifically for veterans with mental or physical impairment who need regular caregiving or must move into assisted living. Applicants are 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 (2021) maximum amount a veteran can receive through A&A is $27,540 per year, and surviving spouses can receive $14,928. Learn more here.
There are also three veterans’ homes in Montana, located in Columbia Falls (in the Flathead Valley near Glacier National Park), Butte (southwestern Montana along the Continental Divide) and Glendive (in the eastern central part of the state). These facilities provide long-term residential care for veterans. In addition to nursing home care, assisted living and memory care are 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. There is often a waiting list because there are a limited number of beds, so 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.