In Tennessee regulations, the two kinds of memory care homes for people with Alzheimer’s disease or related dementia are called “assisted care living facilities” and “residential homes for the aged.” Both types of residences provide room and board for people who need help with activities of daily living (ADLs) like bathing or eating. Assisted care living facilities (ACLFs) are allowed to administer medical care for residents, as well as part-time nursing care and various therapies, while residential homes for the aged (RHAs) cannot provide nursing or medical care.
Both types of residents can house people with dementia in secured wings, if certain stricter rules are followed (see Laws & Regulations below). A difference is that someone in the late stages of dementia may live in ACLFs, while regulations say that RHAs may only house someone with dementia during the early stages of the disease. If your loved one is in the early stages of dementia and lives in an RHA, be prepared for the residence to decide one day that their needs are too great to be met at the residence.
A person with Alzheimer’s or other dementia who lives in an RHA must be assessed at least quarterly (four times per year) to be sure individual needs can be met by the facility.
Assisted living in Tennessee is overseen by the Department of Health’s Division of Health Care Facilities. There are 160 memory care residences in Tennessee, ranging in size from large apartment-complex style communities to smaller settings that are more like a house and serve 12 or fewer people (these are often called board-and-care homes). For free help finding memory care of any size to meet your family’s needs and budget, click here.
The average cost of memory care per month in Tennessee is $4,771, which is about $57,252 annually. Assisted living, without the additional services required for memory care, costs Tennesseans about $1,000 less per month. Tennessee is one of the less expensive states for memory care, with costs below the national average of about $5,000 monthly.
The state’s most expensive place for memory care is Chattanooga, where memory care costs about $5,309 per month and $63,708 annually. The least expensive city for memory care is Morristown (Hamblen County), for about $4,054 per month and $48,648 per year. In Nashville, memory care costs about $4,376 per month and $52,512 annually. The costs in Memphis are $5,166 per month and $61,992 annually. Other cities and costs:
|Tennessee Memory Care / Assisted Living Costs (updated Mar. 2021)|
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People who live near a bordering state may be able to find more affordable memory care outside Tennessee. To the east, North Carolina has a lower average monthly cost for memory care ($4,484) and specifically Asheville, about an hour from Tennessee, averages almost $1,000 less at about $3,228 monthly. Bordering states Kentucky ($4,376), Arkansas ($4,125), Mississippi ($4,376), Alabama ($3,731), and Georgia ($4,125) all average less for memory care than Tennessee, so Tennesseans looking for affordable memory care should look outside the state if possible.
Assisted care living facilities must complete an assessment of every resident before admittance, no later than 72 hours prior to admission, to ensure the fit is appropriate and every care need can be fulfilled there. For memory care in RHAs (which, again, may only admit someone in the early stages of dementia) a medical team must determine that the RHA can adequately manage the disease, and the person must be reassessed quarterly. Assessments are also a way for these communities to record specific details about your loved one’s abilities, needs, personalities, and much more. These unique details are used to create a care plan that helps staff manage a person’s daily needs. For example, an assessment would help determine the best way to engage with your loved one for more open communication, and would list exactly which activities of daily living they cannot do themselves.
Assessments are conducted by medical professionals who work for these residences. The cost of assessing may be included in the base rate, or residences sometimes charge a one-time “community fee” that covers all move-in costs, including the assessment and also things like deep cleaning and painting a new resident’s room. Community fees usually run between $1,500 and $2,500.
ACLFs may not admit a person with the following medical issues:
– Stage III or IV decubitus ulcer or exfoliative dermatitis
– Requires continuous nursing care
– Has an active sickness that requires isolation
– Poses a behavioral threat to self or others
– Requires physical or chemical restraints
– Has needs that cannot be safely met by the ACLF
RHAs may not admit a person with the following medical issues:
– Cannot self-administer medications
– Requires full-time nursing care
– Poses a danger to self or others
– Cannot safely evacuate within 13 minutes
– Requires physical or chemical restraints
There is not a requirement in Tennessee that someone moving into memory care must be officially diagnosed with dementia. Alzheimer’s and related diseases including vascular, Lewy body, and frontotemporal dementias require expensive tests like PET scans for a doctor’s diagnosis, as symptoms can change and vary over time. For this reason, many people with dementia are never diagnosed. The important factor in finding the right home is that staff there can handle your loved one’s unique needs and provide a safe and comfortable environment.
And while it is possible to find memory care on short notice in Tennessee, it’s not a good idea. The process of finding the right home includes inspecting multiple residences and asking questions of staff and people who live there. Once you’ve narrowed your choices, make repeated visits to participate in meals and activities before signing a contract. Ideally, you should begin looking for memory care before the move is necessary. The person with dementia will be able to provide more input the sooner you begin looking.
Living units or bedrooms must provide at least 80 square feet per resident, and there must be at least 15 square feet per resident in the dining area. No bedroom may have more than two beds. There must be one toilet, sink, and bath or shower for every six residents. Sprinkler systems and smoke alarms must be state-approved, and fire drills are conducted at least four times per year.
One important consideration for memory care homes is that the buildings are designed with dementia-friendly features. Tennessee, unlike other states, does not explicitly require easily navigated layouts, circular hallways (so wandering residents don’t encounter dead ends), bright lighting and paint colors, and secured outdoor areas to give residents a safe space for spending time outdoors. These are the types of physical details you should look for when investigating options for your loved one; keep an eye on whether a person with dementia will feel comfortable within the spaces.
There is no staff-to-patient ratio in Tennessee memory care; regulations say staffing must be adequate to serve the needs of every resident. In either type of memory care home, an attendant who is at least 18 years old must be on-duty (and awake) at all times. Administrators must have 24 hours of continuing education every two years, in relevant fields including healthcare, nutrition, and financial management. Assisted care living facilities must have a qualified dietician on staff. Unlike other states, Tennessee regulations do not have specific training or educational requirements for staff.
Residential homes for the aged (RHAs) may only admit someone with dementia in the early stages, and a new assessment must be made by medical staff about every three months to make sure their needs can be met there. This is important to consider when looking for memory care because dementias are progressive, meaning they get worse over time, and that means transfer to an assisted care living facility (ACLF) with memory care for middle and later stages will eventually be necessary. Regulations include language that says someone being discharged (or evicted) because their needs cannot be met should be transferred to a more appropriate community.
This is important: In Tennessee, if you are signing a contact for your loved one to receive memory care in an RHA, be sure to get the details (in writing) about how a transfer will work when their dementia advances into later stages. It is unfortunately a certainty that dementia gets worse, so you must be prepared. A good memory care home will have steps in place.
A resident in an ACLF can be evicted for the following reasons:
– Stage III or IV decubitus ulcers
– Continuous nursing care becomes necessary (though exceptions are possible if arrangements are made between the residence, resident, and outside healthcare professionals)
– Verbal or physical aggression becomes dangerous
– Physical or chemical restraints are required
– Resident cannot evacuate within 13 minutes
Very generally, someone in assisted living cannot remain in the community if their needs cannot be met there. Residences may also have their own rules about evictions and discharges. It’s important to have those rules in writing before agreeing to a move-in contract, because unfair evictions are a major problem in assisted living nation-wide. If you have received an eviction notice in assisted living and need to know next steps, click here.
Medicaid is a jointly funded federal and state program, and in Tennessee the program that provides long-term care and support is called TennCare. Medicaid almost never pays for room and board in assisted living homes, but under the CHOICES program a person can get financial help for services intended to keep someone out of a nursing home. CHOICES is meant to help someone stay in their house or preferred assisted living community by paying for personal care services that assist with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) like bathing, dressing, and grocery shopping. Assistive technologies, like grabbers and devices that help stimulate memory, may also be covered.
To enroll in TennCare CHOICES, a person must be Medicaid-eligible, including monthly income under $2,382 in 2021. For more information on CHOICES, visit the TennCare website here. To enroll, contact your local Area Agency on Aging.
OPTIONS is a non-Medicaid program for Tennesseans older than 18 who need help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Anyone with cognitive disabilities, including Alzheimer’s disease and related dementias, can apply through their local Area Agency on Aging. Benefits include case management, homemaker services, personal care assistance, and meal delivery. There are no income requirements, but there may be a cost depending on someone’s monthly income. Click here for more information.
Due to their higher rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), veterans are statistically more likely to develop dementia. Relevant in all states including Tennessee 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 activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these income improvement 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 (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 four veterans’ homes in Tennessee, which are residential care facilities that provide long-term care for veterans. They are located in Humboldt (northwest Tennessee), Murfreesboro (Upper Cumberland), Knoxville (eastern), and Clarksville (Mid Cumberland). In addition to nursing home care and assisted living, memory care is provided in all four residences. 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 are a limited number of beds available, 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 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 one is waiting for a VA pension to be approved or waiting to sell a home.