New Hampshire defines assisted living facilities as falling under two categories. There is Supported Residential Health Care Facilities and Assisted Living Residence–Residential Care. Each of these homes can house people with dementia in what’s often called Alzheimer’s care or memory care units. Both types of homes offer the following services:
– 24/7 staffing and supervision
– Health and safety services to minimize accidents
– Emergency and crisis response
– Medication assistance
– Food service
– Housekeeping including laundry
– Scheduled on-site activities
An important difference is that Supported Residential Health Care Facilities must provide access to nursing services, rehab, and behavioral healthcare. They are a better choice if your loved one requires a higher level of care, like if there are other health considerations.
The Department of Health and Human Services’ Health Facilities Administration regulates assisted living in New Hampshire. There are approximately 60 memory care homes in New Hampshire. There are also about 46 board and care homes, which offer the same services as assisted living, sometimes including memory care, in a smaller house-like setting for fewer than 12 residents.
Getting your loved one into the right residence is a matter of investigating and asking the right questions. For free help finding memory care to meet their needs and budget, click here.
New Hampshire is one of the more expensive states for memory care. The average cost of assisted living with memory care per month is $7,325. The national average is $5,448 per month. In Manchester, memory care is very costly, running $9,754 per month. Slightly less expensive residences may be found in the more rural areas of the state, for $6,000 monthly. The drawback of looking outside its major cities is that the variety of options is more limited in rural areas.
It is possible to find more affordable memory care outside New Hampshire, but New England is an expensive part of the country for assisted living. Eastern New Hampshire residents can look in Maine, where memory care costs an average of $7,104 per month. Residents in the western part of the state can look in Vermont, where average costs are lower, at $6,368 monthly. To the south, Massachusetts averages $7,877 per month.
New residents in an assisted living home in New Hampshire must be assessed using the state’s Resident Assessment Tool and Needs Determination (available here). Questions are asked about health needs, communication ability, medical history, and more. The assessment must be conducted by a medical professional who works for the residence. This must be done within 30 days before moving in or within 24 hours after move-in. The assessment must be updated every six months, or after a significant health change. The cost of this assessment may be included in the base rate, or it may be part of a community fee that covers all up-front move-in costs including the assessments and details like deep cleaning and painting a new resident’s room. Community fees are usually between $1,500 and $2,500.
Supported Residential Health Care Facilities and Assisted Living Residences – Residential Care cannot admit someone whose needs cannot be met there. Assisted Living Residences – Residential Carehowever, have stricter standards because they do not provide nursing care. To be allowed to move into one of these homes, a person must:
– Be mobile
– Be able to evacuate without help in an emergency
– Be able to move from a bed or chair without special equipment
Both types of assisted living homes in New Hampshire must provide documents with the following information to anyone considering moving in:
– The base rate charged by the residence, and what services it covers
– Staff information including number and training
– Transportation and any other services provided
A copy of the resident service agreement must also be provided, describing all services and costs, and any rules or policies that residents must follow upon admission.
A diagnosis of Alzheimer’s or related dementia is not required to move into memory care. Dementias are difficult to diagnose, with symptoms that change and vary. It is important for the residence to link the symptoms with the proper support enabling the best care for your loved one.
While it is possible to move into memory care on short notice in New Hampshire, this is not a good idea. Finding the right home is a long process that involves looking at every option and asking questions of residents and staff. Additionally, your loved one will be able to provide more input the sooner the search begins. It is best to start looking before moving becomes necessary.
The minimum amount of space for each room depends on the type, size, and when the residence was built. Remember that Assisted Living Residences – Residential Care offer less medical care than Supported Residential Healthcare Facilities, but either can admit people with dementia. Assisted Living Residences – Residential Care must be at least 100 square feet for one resident or 160 square feet for two; however, if the residence was licensed before 2008, the rooms must be 80 square feet for one person and 140 square feet for two people.
If a Supported Residential Healthcare Facilities has fewer than 17 residents, a bedroom must be at least 80 square feet for one person and 160 square feet for two. If there are 17 or more residents, the square footage increases to 100 for one person, but is still 160 for two people. If the home was licensed before 2006, no matter how many people live there, the rule is 80 square feet for one person and 160 for two. Two is the maximum number of people allowed to share a room. One sink, toilet, and tub or shower is required for every six residents.
New Hampshire’s regulations do not require dementia-friendly architectural designs for memory care. It has been proven to be beneficial that time outside in the open air helps with dementia symptoms so you might look for a residence with a secure outdoor area. Clear lines of sight and an easily navigated layout, as well as soft paint colors, have likewise been demonstrated to help keep patients with dementia more comfortable. When you’re finding a new community for your loved one, keep an eye on whether the facilities surroundings will make a good home for your loved one.
In all assisted living residences in New Hampshire, there is a full-time administrator in charge of day-to-day operations who is state-approved with the required educational and professional experience. There are no staff-to-resident ratio requirements; the number of staff is determined by the administrator and must be enough to meet the needs of all residents. Administrators must additionally complete 12 hours of continuing education annually.
Employees are required to pass a background check and also complete annual continuing education. Anyone working with residents or handling food must complete training that covers:
– Residents’ rights
– Complaint procedures
– Specific duties and responsibilities
– Medical emergencies
– Emergency evacuation
– Food safety
New Hampshire regulations do not clearly define why a person can be discharged from assisted living. 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 can be a problem in assisted living. If you receive an assisted living eviction notice, click here for guidance on next steps.
The Choices for Independence waiver is a Home and Community Based Services program for people who need nursing-home level care but want to remain in their own home or assisted living community. If the cost of assistance to cover health needs is less than the cost of fully moving into a nursing home, your loved one may be eligible to receive these funds. Income requirements must also be met, including making less than $2,742 per month in 2023. See New Hampshire full Medicaid eligibility requirements for long term care. Among the benefits provided are skilled nursing care, medical equipment, case management, and more. More information is available here via an online brochure. To apply, contact the New Hampshire Department of Health and Human Services by clicking here. An online Medicaid eligibility test is available to help residents quickly determine if they are eligible.
Veterans are statistically more likely to develop dementia. Among the reasons for this is that traumatic brain injuries and posttraumatic stress disorder lead to a higher probability of developing the condition. The VA offers many benefits for Alzheimer’s and dementia as well as different pension types.
There are three types of VA Pensions available. The benefits change annually and are valid from December 2022 to December 2023. The benefits (and their maximum allowance) are as follows:
1) Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses who are aged or disabled. The qualifying disability does not need to be related to their military service. On an annual basis, the Basic Pension pays:
– Veterans without spouses or children up to $16,073
– Veterans with dependent spouses or children up to $21,001
– Surviving spouses without dependent children up to $10,756
2) Aid & Attendance – Abbreviated as A&A, this is an important program for veterans and their surviving spouses who require assistance with activities of daily living. This means they need assistance with activities like bathing, dressing, and eating. A&A is particularly helpful for people with dementia, especially in the middle and later stages of the disease, when the need for more assistance becomes necessary. A&A is intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s need and the progression of the disease, most of these additional services that support your loved one will become necessary. Annually, the A&A pays:
– Veterans without spouses or children a maximum of $26,751
– Veterans with dependent spouses or children a maximum of $31,713
– Surviving spouses without dependent children a maximum of $17,191
3) Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes, making them require additional assistance. The definition of “home” can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover long-term care costs. Annually, the Housebound pays:
– Veterans without spouses or children a maximum of $19,598
– Veterans with dependent spouses or children a maximum of $24,562
– Surviving spouses without dependent children a maximum of $13,145
There is one veterans’ home in New Hampshire, which is a residential care facility that provides long-term care for veterans. Located in Tilton about 20 minutes north of the state capitol, Concord. In addition to nursing home care, assisted living and memory care may be provided. Neighboring states also have veterans’ homes. Your loved one might consider looking there for more options as there are no requirements that one must live in the state. For example, Maine has six veterans’ homes statewide. Additionally, Massachusetts has two facilities and Vermont has one. More info.
1) Elder care loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.
2) 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 can include assisted living costs.
3) A reverse mortgage can be an option for a married person moving into memory care, if their spouse continues to live in the home. However, if the spouse moves from their home, the reverse mortgage becomes due.