The two kinds of memory care homes for Tennesseans with Alzheimer’s disease or related dementia are called “assisted care living facilities” and “residential homes for the aged.” Both types of residences provide homelike environments 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. 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.
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.
The average cost of memory care per month in Tennessee is $5,105, which breaks down to about $167 per day and $61,260 annually. Remember that all assisted living homes in the state must provide an accurate written statement of fees and services upon admission; file this document to keep as defense against unexpected charges. Assisted living, without the additional services required for memory care, costs Tennesseans about $3,901 per month and $46,812 annually.
The state’s most expensive place for memory care is Cleveland (in Bradley County), where memory care costs about $5,783 per month and $69,396 annually. The least expensive city for memory care is Chattanooga, for about $4,228 per month and $50,736 per year. In Nashville, the state’s biggest city, memory care costs about $5,424 per month and $65,088 annually. The costs in Memphis are $5,384 per month and $64,608 annually.
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.
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
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.
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. Unlike other states, Tennessee regulations do not have specific training or educational requirements for staff.
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 $2,349. For more information on CHOICES, visit the TennCare website here. To enroll, contact your local Area Agency on Aging.
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 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, 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 Tennessee, which are residential care facilities 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 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.