In Pennsylvania, residences that may care for your loved one with dementia fall under two categories: “personal care homes” and “assisted living residences.” There are about 20 times more personal care homes in Pennsylvania than 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 (including, under specific circumstances described below, Alzheimer’s disease and related dementia). The difference is in the amount of care provided; assisted living residences provide full-time nursing care, while personal care homes are for people who do not require 24-hour nursing-home 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) and instrumental activities of daily living (IADLs) 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.)
The average cost of memory care per month in Pennsylvania is $5,145, which breaks down to about $169 per day and $61,740 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.
Assisted living, without memory care, generally costs Pennsylvanians $3,932 per month and $47,184 annually. 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 Lancaster, which costs about $6,701 per month and $80,412 annually. The cheapest is Scranton, at $3,350 per month and $40,200 annually. Philadelphia, the state’s most populated city, costs about $6,382 per month and $76,584 annually. Pittsburgh costs run about $4,268 per month and $51,216 annually.
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 mobility, medications, thinking ability, physical limitations, and personal interests. This must 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).
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. And 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 for personal care homes 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.
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.
Medicaid is a jointly funded state and federal program to help cover the costs of healthcare, but Pennsylvania Medicaid generally does not help 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, which can cover transportation, meals, and more for people who are at least 60. Determine eligibility or read more.
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 $1,205.30 per month, and $1001.60 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.
Pennsylvania has a Social Security supplement that pays around $440 per month based on the type of residential care. Candidates must be SSI-eligible and live in either Dom Care or a personal care home.
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 amount of money added to veterans’ and survivors’ basic pension. 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 go toward the cost of 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 (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive as much as $14,761. Learn more here.
There are also veterans homes in Pennsylvania, which provide long-term 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 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.
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.