In Vermont regulations, an “assisted living residence” must provide housing, healthcare, and personal care services for older adults. Assisted living is meant to be home-like, with state requirements including a private bedroom and private bath for every resident, as well as a living space and kitchen. Vermont regulations also state that an assisted living residence must promote self-direction and active participation in decision making. Health monitoring and medication management assistance are also required.
Vermont has a relatively older population compared to other states (roughly 18% of Vermonters are seniors), and the state is more accommodating than many others for people in assisted living. For example, regulations require larger rooms in residences than in other states. Also, Vermont Medicaid has multiple programs to help pay assisted living costs, while many other states have one or none. For more, see below.
Special approval from the state’s Department of Disabilities, Aging, and Independent Living is required for a residence to admit people with Alzheimer’s disease, or similar dementia, in what’s often called “memory care” (or “Alzheimer’s special care units”). The residence needs to show that it can handle the specialized needs of people with dementia. Requirements include a dementia-friendly physical layout, activities, and special training for staff on communicating with people who have Alzheimer’s or a similar disease including frontotemporal, vascular, and Lewy body dementias.
There are 17 memory care communities in Vermont, ranging in size from apartment-complex-style to smaller house-like residences. For help finding memory care to meet your family’s needs and budget, click here.
The average cost of assisted living with memory care per month in Vermont is $6,278, which is about $75,336 annually. Vermont is one of the more expensive states for memory care, with that monthly rate well above the national average of roughly $5,000. (New England is generally an expensive part of the country for assisted living.) Assisted living without memory care usually costs about $1,000 less and might be appropriate for someone in the early stages of dementia (though a move into memory care will eventually become necessary).
In Burlington memory care costs about $6,278 per month and $75,330 per year. In other Vermont areas outside the Champlain valley, memory-care costs average about $6,242 per month and $74,904 annually.
Looking outside the state might be a good way to find more affordable memory care, but Vermont’s eastern neighbor New Hampshire is actually one of the most expensive states in the country for memory care, averaging about $7,856 per month. To the west, New York state averages much less, about $5,668 monthly, but costs vary widely there. The bottom line is that prices can be quite different in different regions of these states, so be sure to investigate all options before choosing a home, especially if cost is one of your biggest issues.
Within 14 days of moving into a Vermont assisted living community, every new resident must be evaluated using the Vermont Resident Assessment Form, which you can see here. This evaluation must be done by a registered nurse who works for the residence. Information including ability to perform activities of daily living (ADLs) like eating and bathing is used to create a personalized service plan, which helps staff know how to keep your loved one healthy and as active and engaged as possible. These service plans are then regularly updated.
The cost of evaluating might be included in the community’s base rate, or there may be a one-time “community fee” that covers move-in costs including the development of the service plan. Not all homes charge a community fee, but they usually run between $2,000 and $3,000.
There should never be surprises in billing. Prior to moving in, any potential resident in Vermont assisted living must be provided a description of all rates and charges, and an explanation for how those costs might change. A disclosure form is available from any of these residences if asked for, which must include the following information:
– Services the residence can provide
– Public programs or benefits (see below) that the residence accepts or delivers
– All policies related to eviction
For memory care, the residence must provide a written statement of philosophy and mission, as well as details on how the special needs of people with Alzheimer’s or other dementia are met there. An official diagnosis of dementia is not required in Vermont for someone to move into memory care.
An assisted living residence cannot admit someone who needs full-time nursing care, or who otherwise requires a level of care that the residence can’t provide. Residents who pose a threat to themselves or others may not be admitted, or may be evicted if they already moved in.
And while it is possible to move into memory care on short notice in Vermont, this is usually not a good idea. Finding the right residence is a process that should take weeks or months of investigating options, taking tours and asking questions of residents and staff before making a final decision. The person with dementia will also be able to provide more input the sooner you begin looking. Ideally, you would start the search before a move becomes necessary.
Vermont assisted living homes have size requirements for bedrooms and living units that are larger than most other states. Units must be at least 225 square feet, with a bed, bathroom, living space, kitchen, storage, and lockable door. All units in Vermont are for a single person, unless occupants voluntarily choose to have a roommate.
Unlike many other states, Vermont regulations do not define dementia-friendly design features required in memory care. Studies have shown that people with dementia can benefit from easy-to-navigate layouts, secure outdoor areas, and bright lighting and paint colors. As you investigate options, especially during tours, keep an eye out for these design elements and think about whether your loved one with dementia will be comfortable within the spaces.
There are no staff-to-resident ratios in Vermont assisted living, except to say staffing must always be adequate to meet the needs of every resident. All assisted living homes must have a state-certified director who is responsible for the day-to-day management of the residence. Directors must receive 20 hours of continuing education annually, in courses related to the care of residents. Anyone working directly with residents must receive at least 12 hours of training annually, including:
– Residents’ rights
– Fire safety and emergency evacuation
– Emergency response
– Reporting abuse, neglect, or exploitation
– Communicating with residents
– Infection control
– General supervision and care guidelines
Additionally, 24 hours of continuing education is required in courses related to:
– Alzheimer’s disease
– Medication management
– Behavioral management
– Transfers (getting in and out of bed)
– Infection control
Vermont regulations say someone can be evicted for two reasons:
– Behavior that poses an immediate threat to themselves or others
– Care needs cannot be met at the residence
These are pretty vague, but another stipulation in Vermont assisted living is that the process for evictions must be provided in writing to potential residents. Memory care homes can create their own rules for evictions, and it’s important that you be very clear on those rules before agreeing to a move-in contract. Can someone be evicted for non-payment of bills? Is verbal abuse or aggressive behavior considered threatening? What is the process for appeal?
You need to know the answers to these and any other questions related to evictions before agreeing to a move-in contract. Get the answers in writing, because unfair evictions are a major problem in assisted living nationwide. If your loved one has received an eviction notice and you need to know next steps, click here.
Vermont Medicaid’s Global Commitment to Health Waiver provides financial help for costs including assisted living. The goal of the waiver is to keep people who need nursing-home-level care from actually moving into a more expensive nursing home. To receive Global Commitment funds, a person must be Medicaid-eligible—including monthly income in 2021 under $1,100 if you live outside Chittenden County (the county including Burlington), and under $1,191 if you live inside Chittenden. Other programs in Vermont have been wrapped into the Global Commitment to Health program in recent years, including the Choices for Care Waiver and the state’s PACE program. Benefits available to people in memory care include funds to cover the costs of help with activities of daily living, transportation, medical assistance devices, and more. Further information is available here, and you can apply elsewhere on the state’s website. (Vermont Medicaid is also known as “Green Mountain Care.”)
Vermont’s Medicaid recipients who need extra supervision but don’t require full-time nursing care (or can avoid moving into a nursing home with a little extra help) may be eligible for the Assistive Community Care Service program, which provides funds to cover expenses including in assisted living. The benefits include health monitoring, case management, and help with activities of daily living. Consumer direction of services is not available under this program, meaning the state provides guidance on care providers. A person must already be enrolled in Medicaid to receive help under this program. (Enroll here.) Contact your nearest Vermont Agency of Human Services office to apply for ACCS.
This program under Vermont Medicaid (or “Green Mountain Care”) is for people who cannot live alone and need a little extra help staying out of more expensive nursing homes. The Attendant Services Program is meant to keep people in their homes, but the state will consider applicants who live in assisted living communities (including those with memory care). Eligibility requirements are considered more lenient for this program than the Medicaid programs above, so someone who makes more than the income limit may still be eligible for benefits, for example. This is a self-directed benefit, so recipients have a say in how they use the funds to cover care. Help with activities of daily living is among the benefits. For more information, click here. To apply, contact the Vermont Department of Disabilities, Aging, and Independent Living.
Because of their increased 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 Vermont is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is 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 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 $14,928. Learn more here.
There is also one veterans’ home in Vermont, which is a facility providing long-term residential care for veterans. The Vermont Veterans Home is located in Bennington, in the southwestern corner of the state. In addition to nursing home care and assisted living, memory care is provided in a certified Alzheimer’s unit (which also helps those with related dementias including vascular, frontotemporal, etc.). 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 service. Because there is often a waiting list, contact the home before visiting to see if your loved one is eligible to live there. For contacts and more information, click here.
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 can be deducted, and that might 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, the reverse mortgage would become due.
Elder care loans are for families to cover 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.