In Pennsylvania regulations, residences that may care for your loved one with dementia fall under two categories: “personal care homes” and “assisted living residences.” There are about 1,200 personal care homes in Pennsylvania and fewer than 50 assisted living residences. Very broadly, both provide food and shelter for residents who are older, have a physical disability, and/or have mental illness or an intellectual disability. Under specific circumstances described below, Alzheimer’s and related diseases (including vascular, frontotemporal, and Lewy body dementias) fall under this category of intellectual disabilities.
The difference between the two types is in the amount of care provided; assisted living residences provide full-time nursing-home care, while personal care homes are for people who do not require 24-hour nursing care. Someone with dementia, particularly in later stages, requires care and round-the-clock supervision from trained staff, but not necessarily full-time nursing. Homes that cater to people with Alzheimer’s are often called memory care.
Personal Care Homes may assist with activities of daily living (ADLs) like eating and bathing, and instrumental activities of daily living (IADLs) like shopping and administering medications, but their regulations aren’t as strict as assisted living. Assisted living must provide the following:
– 24-hour supervision, monitoring and emergency response
– nutritious meals
– activities encouraging socialization
– basic cognitive support services
– transportation and medication assistance
An assisted living residence is also required to enable supplemental care, so employees there will connect residents to outside medical help including physical therapy, hospice, and more general needs like dental and vision appointments. Personal care homes, on the other hand, do not need to coordinate with outside healthcare.
Personal care homes and assisted living residences are regulated by the Pennsylvania Department of Human Services. Both types of residences house more than four people and hire staff trained to provide assistance with ADLs. (For more on Pennsylvania state regulations, including rules about size and safety, see below.)
There are 390 memory care homes in Pennsylvania. There are also 275 board and care homes, which offer the same services as assisted living and personal care homes, sometimes including memory care, in a smaller house-like environment for 12 or fewer residents. For free help finding memory care of any size to meet your family’s budget and needs, click here.
The average cost of memory care per month in Pennsylvania is $4,663, which breaks down to about $55,956 annually. The services covered by these costs in personal care homes is broadly defined as help with ADLs and IADLs. In assisted living, regulations are much more specific, and so costs cover the following:
– 24-hour monitoring and emergency response
– nutritious meals and snacks
– assistance with ADLs
Further assistance, like transportation, medication management, occupational therapy, physical therapy, and more, may increase the costs.
Pennsylvania is one of the country’s most populated states, and pricing varies widely depending where you live. The most expensive place for memory care is also the most populated city in the state: Philadelphia costs about $6,529 per month and $78,348 annually. The least expensive is Scranton, at $2,906 per month and $34,872 annually. Pittsburgh’s costs run about $4,197 per month and $50,364 annually. Other Pennsylvania cities with memory care costs:
|Pennsylvania Memory Care / Assisted Living Costs (updated Feb. 2021)|
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Pennsylvania is in the lower half of states’ average memory care costs; the national average is about $5,000. If you live in western Pennsylvania, it might be possible to find more affordable memory care in Ohio, but the prices there are generally higher at about $5,130 per month. Northern Pennsylvanians could look in New York, where costs average about $5,668 monthly but vary so widely that it still may be possible to find savings.
In Pennsylvania there are a number of conditions a person must meet in order to be admitted to a personal care home or assisted living residence. Personal care homes are not allowed, for instance, to admit someone who needs full-time nursing-home care. A person with special needs may live in a personal care home so long as the home demonstrates it can adequately address those needs.
Assisted living may not admit anyone with the following medical issues or needs without approval from the Department of Human Services:
– Ventilator dependency
– Vascular ulcers that are not healing
– Continuous intravenous fluids
– Infectious diseases requiring isolation
– Physical restraints
Both types of residences require every resident to have a written program describing the specific needs of the person and the services the residence intends to provide. Among the issues assessed are:
– thinking ability
– physical limitations
– personal interests
An assessment to create this program will be completed within 15 days of admission for personal care homes, and implemented within 30 days of moving it, and it all must be in writing. In assisted living, the assessment must be made within 30 days of moving in.
For people with dementia, personal care homes are required to have an additional cognitive assessment by a doctor or geriatric assessment team within 72 hours of admission to a dementia care unit. Memory care residents must be reassessed annually. Assisted living residences must follow those same guidelines for memory care residents. In assisted living, a support plan must be developed within 72 hours of preadmission, and this plan must be revised quarterly (so four times per year).
Assessments are made by medical professionals who work for the memory care communities, not your personal doctor (though exceptions may be possible). The cost of assessing is often included at no additional cost when a new resident signs a contract, but this is not always the case; some residences charge a “community fee” that covers move-in costs including the assessments. Community fees are usually between $1,500 and $2,500.
An official diagnosis of dementia is not required to move into memory care in Pennsylvania. Diagnosing dementia is difficult and involves expensive tests like PET brain scans. If your loved one has dementia symptoms, the screening and assessments will be able to determine whether a home is appropriate for their stage of dementia.
Room size regulations are different for personal care homes and assisted living residences. Personal care home living units must be at least 80 square feet. If there are multiple occupants, there must be 60 square feet per resident. A bedroom for people with mobility needs (who can’t move around without assistance) must be at least 100 square feet per resident, and allow total access. In assisted living, on the other hand, a room must be at least 225 square feet, or 300 square feet for two occupants. Two occupants is the maximum allowed in one room in an assisted living residence, whereas in personal care homes up to four people can be roommates.
Personal care homes require one toilet and sink for every six residents, and one tub or shower for every 10. Assisted living regulations say there must be a toilet, sink, and tub or shower in every living unit. Safety regulations are similar in both personal care homes and assisted living. There must be two exits on every floor, smoke detectors within 15 feet of every room, and monthly fire drills, with a nighttime fire drill required every six months. Personal care homes are not allowed to have key-operated locks; all locks must be magnetic and able to automatically open if the fire alarm sounds. In assisted living, standard key locks are allowed with permission from the Department of Labor and Industry.
Unlike other states, Pennsylvania does not have a requirement that memory care homes be designed with dementia-friendly features. For this reason, keep a close eye on the physical spaces when investigating options for your loved one. People with dementia have been shown to benefit from time spent in open air, so look for a secure outdoor area. Clear sight lines, a simple layout, circular hallways that don’t run to dead ends, bright lighting, and soft paint colors have all been demonstrated by studies to help people with Alzheimer’s disease or related dementia. People with dementia will eat more when the dining area has bright lighting, for example.
Neither personal care homes nor assisted living residences are required to maintain a specific staff-to-patient ratio. Rather, the rules simply state there must be enough staff to adequately meet the needs in every resident’s support plan (see Admission Requirements above). Regulations do say, however, that for every 50 residents there must be one staffer at all times trained in CPR and first aid. In assisted living, there must be one CPR and first-aid-trained person, present at all times, for every 35 residents.
Direct-care staff in personal care homes must be at least 18 years old, with a high school diploma or GED. In assisted living, an administrator must be on-hand for 36 hours or more per week. A licensed nurse must be available (at least on-call) at all times. In personal care homes, an administrator must be on-hand at least 20 hours per week. Unlike personal care homes, an assisted living residence must have a dietician on staff.
In both personal care homes and assisted living residences, direct-care staffers must be at least 18 years old with a high school diploma or GED. Their training must include:
– Orientation on topics including fire safety, emergency preparedness, residents’ rights, and reporting abuse.
– Training and competency programs for assistance with ADLs.
Personal care homes require 12 hours of training annually for staffers. In assisted living residences, 16 hours of training are required annually, and at least two hours of dementia-specific training.
A residence in Pennsylvania has to give someone 30 days notice before evicting. If an eviction becomes necessary, there are other requirements as well: The home must provide a reason for the eviction, the name of a new residence or location the evicted resident can relocate to, and the method for appealing the decision to evict.
Very broadly, a home cannot allow someone to live there if staff cannot meet their needs. The screening process should determine appropriateness before a move-in, but if a resident’s health were to suddenly change then an eviction might become necessary. If a home cannot accommodate residents who are non-ambulatory, for instance, then a person who loses the ability to walk would not be able to keep living there. If full-time nursing care becomes necessary, then your loved one may need to transfer into a nursing home. Keep in mind, however, that special accommodations are allowed by the state if the home contracts with outside medical professionals to help keep a person in their memory care community.
It’s very important to be clear on eviction policy before moving into a memory care community, because unfair evictions are a big problem in assisted living nationally. Ask what can get someone evicted (Aggressive behavior? Non-payment of bills?) and what the next steps are. Get answers that are as specific as possible in writing. If you received an eviction notice and need to know next steps, click here.
Medicaid is a jointly funded state and federal program to help cover healthcare costs, but Pennsylvania Medicaid generally will not cover room and board costs in assisted living or personal care homes. People who are at least 60 years old, and have been evaluated as needing some nursing-home level care but reside in assisted living or at home, may be eligible for the Department of Aging Waiver in Pennsylvania. The waiver is a Home and Community Based Services (HCBS) waiver to cover transportation, meals, and more for people who are at least 60. Determine eligibility or get more information here.
Pennsylvania’s Domiciliary Care services, called PA Dom Care, is an alternative to assisted living and personal care homes. Someone who lives in the home of a caregiver is eligible, and the program is meant to incentivize staying in a household-style environment for longer periods of time (though the caregiver being paid through the program cannot be a relative). After the home is certified by Area Agencies on Aging, an individual with Social Security will receive $1,228.30 per month in 2021, and $1018.60 goes to the caregiver, with the rest kept as a needs allowance. Couples receive a little less than twice as much. Apply through your local Area Agency on Aging (click here). For a list of Dom Care guidelines, click here.
Pennsylvania has a Social Security supplement that pays more than $1,200 per month to qualified individuals living in personal care homes or in Dom Care. To qualify, a person must have very little income and resources. You must also apply for all government benefits for which you might be eligible. For more information, including how to contact the Social Security Administration, click here.
Because traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are more common for those who served in combat, veterans are statistically more likely to develop dementia. Relevant in all states including Pennsylvania is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is an enhanced monthly benefit added to veterans’ and survivors’ basic pensions. Applicants must be at least 65 years old (or disabled) and require assistance with ADLs like eating, bathing, and moving around. The cash assistance from these pensions can be used as the recipient wishes, meaning it can pay for memory care. In addition, the cost of residential care can be deducted from one’s 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 as much as $14,928. Learn more here.
There are also six veterans’ homes in Pennsylvania, which provide long-term care for veterans. They’re located in Hollidaysburg (central PA, near Altoona), Erie (northwest), Spring City (southeast, about 45 minutes outside Philadelphia), Scranton (northeast), Pittsburgh, and Philadelphia. In addition to nursing home care and assisted living, memory care is provided in all six homes. 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 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. Click here for contacts and more information.
Other ways to help pay for assisted living with 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 can claim your elderly loved one as a dependent). Remember also that medical and dental expenses 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 their 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 you’re waiting for a VA pension to be approved, or waiting to sell a home.