New Hampshire regulations define two types of assisted living homes, each of which can house people with dementia in what’s often called “Alzheimer’s care” or “memory care”: Supported Residential Health Care Facilities (SRHCF) and Assisted Living Residence – Residential Care (ALR-RC). 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 SRHCFs must provide access to nursing services, rehab, and behavioral healthcare. SRHCFs are therefore a better choice if your loved one requires a higher level of care, like if there are other health considerations.
Again, both types of assisted living options may house people with Alzheimer’s disease, or a related dementia, in memory care. The Department of Health and Human Services’ Health Facilities Administration regulates assisted living in New Hampshire. There are 60 memory care homes in New Hampshire. There are also 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.
New Hampshire is one of the more expensive states for memory care. The average cost of assisted living with memory care per month is $7,856 which breaks down to about $94,272 annually. The national average is about $5,000 per month. In Manchester memory care costs about $8,932 per month and $107,184 annually. Slightly less expensive residences may be found in the more rural areas of the state, for about $7,677 monthly and $92,124 per year, but the variety of options is also 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 NH residents can look in Maine, where memory care costs an average of $6,995 per month. Western New Hampshireites can look in Vermont, where average costs are lower, at $6,278. To the south, Massachusetts averages about $7,174 per month and $86,088 annually.
New residents in any assisted living home in New Hampshire must be assessed using the state’s Resident Assessment Tool and Needs Determination (available here) that asks questions about health needs, communication ability, medical history, and much more. The assessment must be conducted by a medical professional who works for the residence, and completed 30 days or fewer before moving in or within 24 hours after move-in. The assessment must then be completed 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 (SRHCF) and Assisted Living Residences – Residential Care (ALR-RC) cannot admit someone whose needs cannot be met there. ALR-RCs, however, have stricter standards because they do not provide nursing care. To be allowed to move into an ALR-RC, 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 like vascular, frontotemporal, and Lewy body dementia is not required to move into memory care. Dementias are difficult to diagnose, with symptoms that change and vary.
And 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. Also, the person with dementia will be able to provide more input the sooner the search begins. It is best, in fact, 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. ALR-RCs 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 an SRHCF 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 an SRHCF 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.
Unlike many other states, New Hampshire’s regulations do not require dementia-friendly architectural designs for memory care. For example, time outside in the open air has been shown to help with dementia symptoms so you might look for a residence with a secure outdoor area. Clear sight lines and an easily navigated layout, as well as soft paint colors, have likewise been demonstrated to help keep people with dementia more comfortable. When you’re finding a new community for your loved one, therefore, keep an eye on whether the actual physical building will make a good home.
All assisted living residences in New Hampshire must employ a full-time administrator, with state-approved educational and professional experience, who is in charge of day-to-day operations. There are no state staff-to-resident ratio requirements; the number of staff is determined by the administrator, and must be sufficient to meet the needs of all residents. Administrators must also have at least 12 hours of continuing education annually.
Employees will pass background checks. In-service training or continual education must be provided annually.
Anyone working directly with residents or handling food must receive orientation that covers the following:
– Residents’ rights
– Complaint procedures
– Specific duties and responsibilities
– Medical emergencies
– Emergency evacuation
– Food safety
New Hampshire regulations do not explain how or why a person can be discharged or evicted from assisted living. This is an important consideration because unfair evictions are a major problem in memory care nationwide. To defend yourself against an unfair eviction, be sure to ask for the residence’s policy on evictions before moving in. Get the answer in writing. (It may be part of the resident service agreement, but be certain.)
Very generally, a person with dementia cannot continue living in memory care in New Hampshire if their medical issues are so bad that they cannot be adequately cared for there. Bottom line: Be certain a residence can handle your loved one’s personal and medical care before moving in, but be sure to acquaint yourself with their eviction policy just in case. 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 (HCBS) waiver for people who need nursing-home level care but want to remain in their own house 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, then your loved one may be eligible to receive these funds (income requirements must also be met, including making less than $2,500 per month in 2021). See NH full Medicaid eligibility requirements for long term care.
Among the benefits provided through CFI are skilled nursing care, medical equipment, case management, and more. More information is available in an online brochure (click here). To apply, contact the New Hampshire Department of Health and Human Services through this link. An online Medicaid eligibility test is available to help residents quickly determine if they are eligible.
Veterans are statistically more likely to develop dementia because of service-related medical issues like traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Relevant in all states including New Hampshire is the VA’s Aid & Attendance pension program, also called “enhanced monthly benefit” or “income improvement pension,” for veterans and surviving spouses, which adds money 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, so 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 is also one veterans’ home in New Hampshire, which is a residential care facility that provides long-term care for veterans. In addition to assisted living, memory care is available in the New Hampshire Veterans Home’s 100-bed Life Enhancement Dementia Unit. Payments are 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 military service. Because there is often a waiting list, contact a home before visiting to see if your loved one is eligible to live there. For details including the NHVH’s contact 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 costs can be deducted, and that may 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 from their home, the reverse mortgage would become due.
Elder care loans are for families to cover initial 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.