Assisted living residences for people with Alzheimer’s disease, or related dementia, are required to be certified with the state as having an “Alzheimer Dementia Special Care Unit / Program.” These residences, often called “memory care,” must meet special requirements for fire safety and medication administration (see below).
The services generally offered in any assisted living home include room and board, meals, housekeeping, and help with activities of daily living (ADLs) like eating and bathing. A residence with an Alzheimer Dementia Special Care Unit / Program must meet additional requirements including a physical layout that is dementia-friendly (like circular hallways and simple layouts), activities that are specifically good for people with dementia, and training for staff that covers how to care for people with the distinct challenges posed by dementia. Memory care homes must also employ a full-time registered nurse.
Assisted living in Rhode Island is regulated by the state’s Department of Health, Center for Health Facility Regulation.
The average cost of assisted living with memory care in Rhode Island is $6,820 per month, which breaks down to about $224 per day and $81,840 annually. Assisted living, without the additional services required for memory care, costs Rhode Island residents about $5,212 per month and $62,544 annually. Regulations require Rhode Island assisted living homes to provide anyone considering moving in with a written statement of all costs. File this document as defense against unexpected charges.
In the state’s largest city, Providence, the average cost of memory care per year exactly matches the state-wide figure of about $81,840. Due to small size of the state, there is not a lot of cost variance within the state.
All new residents in Rhode Island assisted living homes must be evaluated using the state Department of Health’s Assisted Living Resident Assessment, which assesses health needs, eating ability, how well a person communicates, mobility, and much more. This form must be signed by a registered nurse.
Any potential resident is entitled to a document with the following information before moving into an assisted living home in Rhode Island:
– Residence’s owner and operator
– Level of licensure, with an explanation of what the levels mean
– Rules for admissions and evictions
– All services available
– Costs including all fees and deposits
– Details of residency agreements, including residents rights and admissions standards
– Contact information for the state’s Department of Health (which regulates assisted living), the Medicaid Fraud and Patient Abuse Unit, the state ombudsperson, and local police
Importantly for people in memory care, the residence must also disclose the following to people moving into Alzheimer Dementia Special Care Units:
– Staffing patterns
– Ratio of staff to residents
– Training for staff
– Description of physical layout
– Dementia-friendly activities
Thirty-days notice is required before a person can be evicted from assisted living (though 30-days notice is not required if there’s a life-threatening emergency). The reasons a person can be evicted are:
– The residents’ personal or healthcare needs cannot be met there.
– Resident is dangerous to self or others
– Failure to pay bills after more than 30 days outstanding
A room for one person must be at least 100 square feet, and eight feet wide; for two people the rooms must be at least 160 square feet and 10 feet wide. (Those numbers exclude the bathrooms and closets.) The maximum number of people allowed in one room is two. Residences need one tub or shower for every 10 residents and one toilet per every eight.
A Department of Health-certified administrator must be hired to be responsible for operations and safety at all times. There are no staff-to-resident ratios except to say that there must always be enough employees to meet the needs of every resident, and an employee with CPR training must be on-site at all times. All staff who have contact with residents must have a background check, and a registered nurse must visit the assisted living home at least once every 30 days, to make a review of the residence. Staff working with residents with dementia must have at least 12 hours of dementia-specific training annually.
Upon hiring, all assisted-living staff in Rhode Island must have orientation that includes the areas listed below. In addition, ten hours of training on topics including age-related behaviors, helping with activities of daily living, and transferring (such as from a bed to a chair) is also required around the time of hiring, and then annually.
– Fire prevention
– Recognizing and reporting abuse and neglect
– Assisted living philosophy (goals or values like dignity, choice, etc.)
– Residents’ rights
– Emergency procedures
– Infection control
Unlike with Medicaid programs, money from Rhode Island’s Supplemental Security Income Assisted Living Program can go directly toward the costs of room and board in an assisted living home, including one with memory care. Applicants must meet requirements including monthly income less than $1,157 for a single person. People with needs that require nursing-home-level care are not eligible. The program covers costs up to a maximum of $1,212, but people who need advanced care and are enrolled in Medicaid may receive up to $1,568 per month. Click here for more information, including the required forms. To apply, contact Rhode Island’s Aging and Disabilities Resource Center, “The Point,” at 401-462-4444.
The Rhode Island Global Consumer Choice Compact Medicaid Waiver is for people who need health or personal care services, including residents in assisted living and memory care. Benefits include personal care and housekeeping in assisted living, as well as case management and physical therapy. Room and board in assisted living, however, cannot be covered by funds from this program. Financial requirements include monthly income less than $2,349 per month in 2020. More information is available from the state’s Office of Health and Human Services. To apply, contact the Rhode Island Division of Elderly Affairs at 401-462-3000. There may be a waiting list, and people who need a higher level of care are prioritized.
Assisted living is among the benefits covered in the Rhode Island Home and Community Care Co-Pay Program, a non-Medicaid program that helps people who cannot leave their houses or assisted living communities without significant help, or need assistance with activities of daily living like dressing and bathing. There are more covered benefits under the Co-Pay Program than normal Medicaid, and fewer financial restrictions, though there is an income limit of about $21,600 for an individual. For more information, click here. You can apply through the Health Source RI website.
Veterans are statistically more likely to develop dementia. Relevant in all states including Rhode Island 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 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, including going toward the cost of memory care. Also, 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 $14,761. Learn more here.
There are also veterans homes in Rhode Island, which are residential care homes that 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 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 are deductable, 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.