In Washington, D.C., regulations, there are two types of communities that combine housing and health care. They are Community Residence Facilities and Assisted Living Residences. The difference is that Community Residence Facilities may only admit people who are ambulatory (able to move without assistance) and require minimal help with activities of daily living like eating and bathing. Assisted Living Residences, on the other hand, provide care to match a person’s specific needs, which might include hands-on assistance with activities of daily living and more. Because of this, Assisted Living Residences are better for people with dementia. This is true in most cases except for patients in the earliest stages when there may be memory trouble but a person can still function independently.
Unfortunately, residents with dementia in Community Residence Facilities will eventually need to move out into Assisted Living Residences because the progressive disease worsens over time. The community should be able to anticipate this move and help find a suitable home for the middle and later stages. If your loved one with Alzheimer’s or dementia is moving into a Community Residence Facility, be sure to ask how they help with transfers.
Assisted Living Residences must provide recreational and social activities. Other health and social services available to people in assisted living residences in the District of Columbia include:
– Social work
– Home Health
– Psychiatric help
The agency that regulates D.C. memory care homes is the Department of Health’s Health Regulation and Licensing Administration. There are approximately 20 memory care homes in the District of Columbia. Also, there are about 22 board and care homes, which offer the same services as assisted living ( including memory care) in a smaller, more home-like setting for fewer than 12 residents. For help finding memory care in or around the District of Columbia to suit your family’s needs and budget, click here.
The average cost of assisted living with memory care in Washington, D.C., is $7,214 per month. That is considerably higher than the 2022 national cost of memory care which averages $5,448 monthly.
Costs in D.C. are relatively high due to the limited geographic area. Families might consider more rural locations in the surrounding states if they are looking for more affordable memory care options. Maryland’s average monthly cost for memory care is less expensive than D.C.’s, costing $5,926. To the south, Virginia’s prices are close to that, at about $6,368 per month.
Every person moving into community residence facilities and assisted living residences must be assessed by a medical professional within the first 30 days. In Assisted Living Residences with memory care, this assessment is conducted by someone who works for the residence. The assessment defines which activities of daily living, like eating and bathing, a new resident needs help with. It also assesses instrumental activities of daily living, like managing money and medications. An individualized service plan is created using this information which tells staff exactly what help and how much of it your loved one needs.
While the cost of making a service plan is sometimes included in a residence’s base rate, it also might be part of a one-time community fee. Residences often charge community fees to cover up-front move-in costs like assessing and preparing a new resident’s room. Community fees usually run between $1,500 and $2,500.
Anyone considering moving into memory care has the right to a disclosure outlining the contract terms and the costs of all services provided. This means there should never be surprises in billing.
Patients with any of the following health or behavioral issues may not move into memory care in the District of Columbia:
– Are dangerous to themselves or others
– Have health problems that exceed services provided at the residence
– Require more than 35 hours of nursing care per week
– Have stage III or IV skin ulcers
– Requires a ventilator
– Has a disease or condition that requires contact isolation
There is no requirement in Washington, D.C., that someone is diagnosed with Alzheimer’s or a related disease including vascular, frontotemporal, and Lewy body dementia before moving into memory care.
And while it is possible to move into memory care on short notice in Washington D.C., 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.
Living units or bedrooms in memory care must be at least 80 square feet for one person and 120 square feet if there are two occupants. Though there are no additional per-person square footage requirements. Regulations say that up to four people can live in one room. Inspect thoroughly to make sure the space is adequate before moving in. There must be one bathroom for every six residents.
You also should look at facilities with an eye on whether physical designs are dementia-friendly. Unlike many states, D.C. regulations do not include requirements that say memory care homes must be built with a secure outdoor space, clear sight lines, and bright lighting. All these features have been demonstrated to benefit people with dementia.
There are no specific training requirements for staff in Community Residence Facilities. In Assisted Living Residences, including memory care, an employee must be either a certified nursing assistant or undergo at least 40 hours of training approved by the district’s Department of Health. They must also complete orientation training within one week of beginning employment that is specific to the residence. Topics in this orientation include the residence’s care philosophy, resident rights, and services provided. Twelve more hours of in-service training are required annually. An administrator responsible for day-to-day operations must have Department of Health-approved education and work experience. For memory care homes, administrators must have at least 12 hours of training annually on dementia-specific topics. There are no staff-to-resident ratios in District of Columbia community residence facilities or assisted living residences.
A person may be evicted or discharged from a Washington, D.C. memory care home if they develop a medical issue beyond the scope of care provided at the residence. This means that if full-time nursing care is required, they would need to be discharged and transferred to a nursing home. Another example: is if a residence cannot admit non-ambulatory patients, then someone who loses their ability to walk would need to find a more appropriate place to live.
How and why a person can be evicted or discharged is not defined in regulations, and residences can create their policies. It is very important to be clear on these policies before signing a move-in contract because unfair evictions can be a major problem in assisted living nationwide. Can a person be evicted for aggressive behavior or late payment of bills? How much advance notice is given before moving out is required? The standard is 30 days, does this facility follow the same norm? How do you appeal a decision? It’s important to ask these questions and get the answers in writing. For more on evictions and discharges in memory care, including the next steps if your loved one receives an eviction notice, click here.
This is a Home and Community-Based Services waiver available from District of Columbia Medicaid. It’s designed to pay for services that help someone stay in their home or assisted living residence rather than moving into more expensive nursing care. Medicaid cannot cover the costs of room and board in assisted living, but services including personal care (help with activities of daily living), therapies, and case management are covered. The program is designed for customization based on a person’s specific needs. Recipients must be Medicaid-eligible, including monthly income under $2,742 in 2023 (though there may be help available for those who don’t meet requirements including the monthly income cap). For updated information including how to apply, click here or contact the Washington D.C. Aging and Disability Resource Center at 202-724-5626. Learn more about Medicaid eligibility.
Veterans are statistically more likely to develop dementia. Among the reasons for this is that traumatic brain injuries and posttraumatic stress disorder lead to a higher probability of developing the condition. The VA offers many benefits for Alzheimer’s and dementia and different pension types.
There are three types of VA Pensions available. The benefits change annually and are valid from December 2022 to December 2023. The benefits (and their maximum allowance) are as follows:
1) Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses who are aged or disabled. The qualifying disability does not need to be related to their military service. On an annual basis, the Basic Pension pays:
– Veterans without spouses or children up to $16,073
– Veterans with dependent spouses or children up to $21,001
– Surviving spouses without dependent children up to $10,756
2) Aid & Attendance – Abbreviated as A&A, this is an important program for veterans and their surviving spouses who require assistance with activities of daily living. This means they need assistance with activities like bathing, dressing, and eating. A&A is particularly helpful for people with dementia, especially in the middle and later stages of the disease, when the need for more assistance becomes necessary. A&A is intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s need and the progression of the disease, most of these additional services that support your loved one will become necessary. Annually, the A&A pays:
– Veterans without spouses or children a maximum of $26,751
– Veterans with dependent spouses or children a maximum of $31,713
– Surviving spouses without dependent children a maximum of $17,191
3) Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes, making them require additional assistance. The definition of “home” can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover long-term care costs. Annually, the Housebound pays:
– Veterans without spouses or children a maximum of $19,598
– Veterans with dependent spouses or children a maximum of $24,562
– Surviving spouses without dependent children a maximum of $13,145
There is not a single veterans’ home in Washington D.C. Residents living near other state borders may find more state veterans’ home options crossing state lines, and many of those offer memory care. They are facilities that provide long-term residential care for veterans. In addition to nursing home care and assisted living, memory care can be provided in certified Alzheimer’s units. Your loved one might consider looking there for more options as there are no requirements that one must live in the state. For example, Virginia has two facilities statewide. There is the Sitter and Barfoot Veterans Care Center in Richmond where there is a 40-bed dementia special care unit. The second facility is the Virginia Veterans Care Center in Roanoke where there is a 60-bed dementia special care unit. Additionally, to the north, in Maryland, there is one home located in Charlotte Hall. Located on the Chesapeake Bay in the southern part of the state there is also a dementia care unit. More info.
1) Eldercare loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.
2) 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 can include assisted living costs.
3) A reverse mortgage can be an option for a married person moving into memory care, if their spouse continues to live in the home. However, if the spouse moves from their home, the reverse mortgage becomes due.