An “assisted living facility” in Nebraska is defined as a residence where shelter, food, and care are provided 24 hours per day for people who need these services because of age, illness, or disability. Assistance with activities of daily living (ADLs) like eating and bathing must be offered by the residence. Other services provided may include:
– Non-complex nursing care
– Money management
– Behavior therapy
– Beauty/barber services
– Religious services
Assisted living for people with Alzheimer’s disease or another dementia (also called “memory care”) is defined as an “Alzheimer’s special care unit” in Nebraska. These units must take extra measures, including a physical environment appropriate for residents with Alzheimer’s and dementia-specific training for staff (see below).
Assisted living in Nebraska is regulated by Health and Human Services.
The average cost of assisted living with memory care in Nebraska 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.
In the state’s largest city, Omaha, the average cost of memory care is $5,265 per month and $63,180 annually. Memory care is most expensive in Lincoln, where it costs about $7,698 per month and $92,376 annually. The least expensive place for memory care in Nebraska is outside its cities in rural areas, for about $4,427 per month and $53,124 annually. Unfortunately, rural Nebraska does not offer many assisted living options.
A written service agreement must be negotiated with every resident before move-in, detailing medical and personal needs and the services to be provided. The agreement must be specific about how these services will be administered. It must also include all costs and fees, including optional or additional charges. This agreement must be reviewed and updated as the person’s needs change.
Anyone considering moving into assisted living in Nebraska is entitled to the following information in writing:
– Description of all services provided
– Description of staff and qualifications
– Policy regarding whether residence accepts Medicaid waiver funds (see below)
– Criteria for admission, and any issues that might disqualify someone from admittance
– Process for writing a resident services agreement
– Residents’ rights
– Description of all costs
– Whether or not nursing care is provided, and at what level
In special care units (memory care) for residents with Alzheimer’s disease or another dementia, the services that are especially for people with dementia must be listed in writing as well.
Living units for residents in assisted living must be at least 80 square feet for one person, and 60 square feet per person if there are roommates. For new homes, the requirements are larger: 100 square feet for one person and 80 square feet per person for multiple occupants. New homes may not have more than two people in a single unit, but up to four roommates are allowed in older assisted living residences. One bath or shower must be provided for every 16 residents in older facilities, and for every eight residents in newer homes. These must all have grab bars or other assistive devices. A toilet and sink must be adjacent to every living unit, except in older residences where there must be at least one toilet for every six residents.
Memory care residences must have physical designs that are appropriate for people with dementia. This usually means design features like a simple layout with landmarks and clear sight lines, and quiet rooms with minimal distraction. A description of the physical layout and how it is appropriate must be provided to anyone considering moving in.
There is no staff-to-resident ratio required in Nebraska, except to say staffing must be sufficient to meet the needs of every person living there. Each residence must employ an administrator responsible for planning, organizing, and day-to-day operations. Administrators must be approved by the state. Required administrator training is 30 hours including:
– Residential care and services
– Social services
– Financial management
– Gerontology (the science of aging)
– Rules and regulations
Residences must have a registered nurse on-call to review medication administration policies and to train anyone who helps residents with their medications. Staff must receive orientation upon hiring that includes overviews of residents’ rights, service plans, and emergency procedures. Additionally, 12 hours of continuing education are required annually. In memory care, staff must be trained specifically to help people with dementia, including four hours of additional annual training covering these topics:
– Philosophy for treating people with dementia
– The stages of Alzheimer’s disease and how the illness progresses
– Techniques for assisting with ADLs
– Behavior difficulties
This state Medicaid waiver is designed to help cover the costs of living with illness at home or in assisted living. Medicaid cannot pay for room-and-board in assisted living, but services may be covered, including personal care, meals, laundry, medical equipment and more. Recipients must be Medicaid-eligible, including income under $1,603 per month for an individual (though there may be exceptions available for people deemed medically needy). Because the program is approved for a specific number of people (about 7,200 as of this writing), there may be a waiting list. For additional information, click here. To apply, contact the Nebraska Department of Health and Human Services at 1-800-538-8802 or your local Area Agency on Aging.
Veterans are statistically more likely to develop dementia. Relevant in all states including Nebraska 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 four veterans’ homes in Nebraska located in Grand Island, Norfolk, Bellevue and Scottsbluff. 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. Waiting lists for admission may exist, therefore contact a home before visiting to see they have availability.
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.