In Virginia regulations, memory care is called “special care units” within assisted living residences. These communities are specifically for people with Alzheimer’s disease or related dementia, providing personal and healthcare services, 24-hour supervision, social and recreational activities, and anything else in residents’ personal service plans. Staff needs to be trained to provide assistance with activities of daily living (ADLs), like eating and bathing, and instrumental activities of daily living (IADLs), like managing money or medications.
It should be easy to get the information you need for an informed decision about moving into a memory care residence. 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
– Reasons a person can be discharged or evicted
– 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 regulatory body overseeing assisted living homes in Virginia is the Department of Social Services. There are about 240 memory care homes in Virginia. There are also 145 board and care homes, which offer the same services as assisted living (sometimes including memory care) for 12 or fewer residents in a more house-like setting. For free helping 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 Virginia is $5,704, or $68,448 annually. This puts Virginia slightly higher than the roughly $5,000 national average for memory care costs. Assisted living without the specialized care that comes with memory care costs about $1,000 less, and may be appropriate for people in the earliest stages of dementia, though a move to memory care will eventually become necessary.
The most expensive place for memory care in Virginia is Harrisonburg, running about $7,426 per month and $89,112 annually. The least expensive memory care is outside the state’s cities, as rural areas average about $3,480 per month and $41,760 annually. In Virginia Beach, the state’s most populated city, memory care costs about $5,166 per month and $61,992 annually.
People living in the western or southern areas of Virginia might be able to find more affordable memory care across the state border. West Virginia and North Carolina both have less expensive overall memory care costs. West Virginia averages almost $1,000 less per month, at $4,735; and North Carolina’s averages are even lower, at roughly $4,484 per month. These figures vary, but if cost is your top concern it might be smart to widen your search to areas outside Virginia. (Maryland, to the east, costs more at about $5,883 monthly.)
Virginia memory care homes use the Uniform Assessment Instrument (UAI) to evaluate the health and abilities of all residents. The assessment is filled out by a qualified assessor, usually a doctor or registered nurse, who works for the residence. A personal doctor may also fill out this assessment. Anyone receiving state subsidies (see Financial Assistance below), will also be assessed by a health professional working for the state’s Department of Social Services. 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.
The cost of assessments may be included in the base rate at the residence, or there may be a one-time “community fee” that covers up-front move-in costs including assessing and also deep cleaning and painting a new resident’s room. Community fees usually run between $1,500 and $2,500.
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
There are other physical design elements in memory care homes that you should look for, but are not explicitly required by Virginia regulations. Studies have shown that easily navigated layouts, bright lighting and paint colors, and circular hallways that don’t dead-end are beneficial for people with dementia.
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.
Unfair evictions are a major problem in assisted living around the country, so it’s important that anyone moving into a memory care home has a clear understanding of the rules about evictions before signing a contract. In Virginia, there is a requirement that anyone who might move into an assisted living home be given a written statement with information including “criteria for discharge.” This means Virginia residences have their own rules for kicking someone out, and they must be provided in writing.
Very generally, someone can be evicted or discharged if they need medical or personal care that staff are unable to provide. If a memory care home can’t care for someone who is non-ambulatory, for instance, then a person who loses the ability to walk would need to be evicted. Other examples might be someone who needs to be fed intravenously, or develops an illness requiring full-time nursing care.
But it’s also important to know if aggressive behavior might get someone evicted. Can your loved one be asked to leave if bills are not paid on time? And what is the process of eviction? How much warning is provided? (The standard is 30 days.) And what is the process for appeal?
Again, it’s important to be clear on how and why your loved one can be evicted before moving into a memory care home. Ask these questions and get the answers in writing. If you receive an eviction notice and need to know next steps, click here.
This program, abbreviated as CCC+ or CCC-Plus, serves over 250,000 people in Virginia by providing help with medical, behavioral health, and long-term care services. To receive this waiver, a person must be Medicaid-eligible (click here for VA Medicaid eligibility test), require a level of care at the hospital or nursing-home level, or be considered “medically complex.” Someone with dementia who lives in memory care may qualify based on an assessment. Benefits of this program include case management, personal care assistance, help covering costs of assistive devices, physical therapy, lab tests, and more. Eligible recipients are assigned a care coordinator who works with providers in their parts of the state. Apply by contacting your local Department of Social Services office.
The non-Medicaid state program called Virginia Adult Services helps people in low-income families, who need significant healthcare, pay for a number of specific services that are meant to keep a person out of full-time nursing care. These include nutritional counseling, assessments for assisted living residences, transportation to appointments, case management, chore services, and more. An assessor for the state will determine the amount of care, including how many hours weekly, a person receiving this benefit requires. Financial eligibility depends on where someone lives in the state. For more information, including a downloadable application, click here. You can also apply by contacting 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.
Because they have 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 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 pensions. (A&A is also known as the Income Improvement Pension.) Applicants must be disabled or at least 65 years old 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 two veterans’ homes in Virginia, which are residential care facilities that provide long-term care for veterans. They are the Virginia Veterans Care Center in Richmond and the Sitter & Barfoot Veterans Care Center in Roanoke. In addition to nursing home care and assisted living, memory care is 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. For contacts and much 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 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.