In Nebraska regulations, an “assisted living facility” 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 also be available. 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. There are 175 memory care communities in the state. Unlike almost every other state, Nebraska does not have board-and-care homes offering the same memory-care services in a smaller, house-like setting (usually less than 12 people). It is possible, however, to find smaller living options for a loved one with late-stage dementia. For free help finding memory care to meet your needs and budget, click here.
The average cost of assisted living with memory care in Nebraska is $4,950 per month, which breaks down to about $59,400 annually. This puts Nebraska at about the same as the national average of around $5,000 per month for memory care.
In the state’s largest city, Omaha, the average cost of memory care is $5,345 per month and $64,140 annually. Memory care is most expensive in Lincoln, where it costs about $5,596 per month and $67,152 annually. The most affordable place for memory care in Nebraska is outside its cities in rural areas, for about $4,125 per month and $49,500 annually. Unfortunately, rural Nebraska does not offer many assisted living options.
While the states to Nebraska’s south, Colorado and Kansas, both average higher costs for memory care than Nebraska ($5,381 and $5,991 per month respectively), residents in the northern and western parts of Nebraska might find more affordable options in South Dakota ($4,305 per month average) and Wyoming ($4,914). These are averages, so costs will of course be varied, but remember it may be possible to find savings outside your state. Regardless of state, assistance is available finding memory care communities for a loved one. Get help here.
A written service plan must be negotiated with every resident before move-in, detailing medical and personal needs and the services to be provided. This 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.
The process for developing this plan must be explained in writing to anyone considering moving in. An assessment by a medical professional who works for the residence will be part of this, but there is no standard form. Getting assessed is part of moving in, so there may be an additional fee to cover the cost of assessment as well as other up-front expenses like deep cleaning and painting the new resident’s room. This fee is usually called the “community fee” and runs between $1,500 and $2,500.
A person does not need an official diagnosis of Alzheimer’s, or related dementia including vascular, frontotemporal, and Lewy body dementia, to move into memory care in Nebraska. And while you may be able to move into assisted living in Nebraska on short notice, this is not a good idea because the process of finding the right community takes thorough investigation of all options, including asking questions of residents and staff at any home you’re considering. Your loved one with dementia will also be able to provide more input if you begin the search early, before a move is necessary.
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 Nebraska 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, but these are not defined in regulations. There are not specific requirements for outdoor spaces that are secure, or other design features that benefit people with dementia, so look for these and be sure your loved one will be comfortable in the spaces before agreeing to move in. 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
A Nebraska memory care community is required to give 30 days’ notice to someone being discharged or evicted, unless a person needs to leave immediately for the health and/or safety of residents and staff.
The reasons a person can be evicted, transferred, or discharged are not defined in regulations, so there is not one set of rules. This means every residence has its own rules about why a person can be asked to leave. One fairly common reason is that their health has deteriorated to a point where the services there aren’t enough. Other reasons might include aggressive behavior, or non-payment of bills. Be sure to ask for the specific reasons a person can be evicted before agreeing to a move-in contract. Get the answer in writing and keep it on file, because unfair evictions are a major problem in assisted living.
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. Other names for A&A are the “enhanced monthly benefit” and “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 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 four veterans’ homes in Nebraska located in Kearney (in the central part of the state), Norfolk (northeast), Bellevue (outside Omaha) and Scottsbluff (western panhandle). These are facilities providing 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. Waiting lists for admission may exist, therefore contact a home before visiting to see they have availability. For contacts and more information, click here.
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.