In Virginia, memory care is called “special care units” within assisted living residences. These communities are specifically for people with Alzheimer’s disease or other dementia, providing personal and healthcare services, 24-hour supervision, social and recreational activities, and anything else in residents’ personal service plans. Assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are required by state regulations. The regulatory body overseeing assisted living homes in Virginia is the Department of Social Services.
It should be easy to get the information you need for an informed decision about moving your loved one into memory care. Anyone considering assisted living in Virginia is entitled to a disclosure statement from the home, with the following information:
– Ownership structure of the residence
– Description of services offered, including healthcare
– Description of fees, including an explanation of what’s provided for the base fee and all possible additional fees
– Criteria for admission, and possible restrictions
– Criteria for discharge or eviction
– Residence’s liability insurance
An administrator at any memory care home in Virginia is required to give written assurance to a new resident that the facility can adequately provide for all health needs, based on the Uniform Assessment Instrument (see Admissions Requirements below).
The average cost of memory care per month in Virginia is $6,302, which breaks down to about $207 per day and $75,624 annually. Part of the disclosure statement that should be given to anyone considering an assisted living home with a special care unit (memory care) is a full list of fees, including anything that might be additional to the base cost. In other words, there should be no surprise charges.
Assisted living, without the additional services required for memory care, costs Virginians about $4,816 per month and $57,792 annually.
The most expensive place for memory care in Virginia is Charlottesville, running about $7,618 per month and $91,416 annually. The cheapest is Roanoke, which costs families about $4,986 per month and $59,832 annually. In Virginia Beach, the state’s most populated city, memory care costs about $6,063 per month and $72,756 annually.
Virginia memory care homes use the Uniform Assessment Instrument (UAI) to evaluate the health and abilities of all residents. (There are different forms of the UAI for people who pay privately and people whose costs are subsidized.) The UAI, available at this link, must be completed at most 90 days before admission. All residents must also have a physical exam before admission. Another piece of the individualized service plan every person in memory care receives is a fall risk rating, to determine how likely it is for someone to fall and get hurt.
Anyone with these conditions cannot be in assisted living in Virginia:
– Ventilator dependency
– Stage III or IV dermal ulcers
– Need for intravenous therapy or injections directly into veins
– Airborne infectious diseases requiring isolation
– Psychotropic medications without appropriate prescription
– Nasogenic and (in some cases) gastric tubes
– Need for continuous nursing care
– Any physical or mental health needs that the residence cannot provide
Private units must be at least 100 square feet for a single, or 80 square feet per person if there are multiple occupants. Two is the maximum number of people allowed per bedroom, unless the residence was constructed before 2006. Assisted living older than 2006 can have up to four people in one bedroom. There must be one toilet and sink for every four residents, and a tub or shower for every seven.
Special care units (memory care) within assisted living residences must also have:
– Security monitoring for all doors that lead outside
– Protective devices on windows
– An easily accessed walking area
Every assisted living community in Virginia must have on its staff (or kept under contract) a licensed healthcare professional qualified to provide oversight on the care of residents. They also need someone licensed to review medications, special diets, and (if nursing treatments are required by any resident) a licensed nurse. Each staff member must be certified in first aid, and must keep the certification current. One CPR-certified employee must be working at all times.
There is no specific staff-to-resident ratio in Virginia. Rather, regulations say there must be a sufficient number of workers, each with adequate knowledge and skills, to provide for the well-being of every resident and implement a fire plan or emergency evacuation.
Anyone working directly with residents must have 18 hours of annual training in skills and knowledge directly related to the residence’s population. Administrators must be at least 21, with a high school diploma or GED and at least 30 credit hours from a college or university, in classes directly related to the job. They also must be licensed by the Virginia Board of Long-Term Care Administrators. Twenty hours of state-approved training are required annually.
In Virginia, Medicaid does not have programs that help pay for assisted living. There is, however, a state program called Virginia Adult Services that helps people in low-income families, who need significant healthcare, pay for a number of specific services. These benefits are meant to keep a person out of full-time nursing care, and include nutritional counseling and assessments for assisted living residences. To apply, contact the Virginia Department for Aging and Rehabilitative Services.
Virginia Auxiliary Grants can help cover assisted living costs for people who also receive Supplemental Security Income. The application criteria are incredibly complex, but among the qualifiers are a need for help with ADLs, a need for assistance with taking medications, and difficulty controlling disruptive behavior (as people who have Alzheimer’s are known to exhibit). Someone must already be in assisted living or adult day care to apply. People who receive auxiliary grants must be assessed annually by the Department of Social Services. For a brochure on the program, click here. Apply through the Department of Social Services.
Veterans are statistically more likely to develop dementia. Relevant in all states including Virginia 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 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 Virginia, 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.