In Washington, D.C., regulations, the two types of communities that combine housing and health care are Community Residence Facilities (CRFs) and Assisted Living Residences (ALRs). The difference is that CRFs 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. ALRs, 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. For this reason, ALRs are better for people with dementia, except in the earliest stages when there may be memory trouble, but a person can still function independently.
Unfortunately, residents with dementia in CRFs will eventually need to move out into ALRs because the disease is progressive, meaning it 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 related disease is moving into a CRF, be sure to ask how they help with transfers.
ALRs must provide recreational and social activities. Other health and social services that should be made 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 20 memory care homes in the District of Columbia. There are also 22 board and care homes, which offer the same services as assisted living (sometimes including memory care) in a smaller, more house-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 $7,067 per month, which is about $84,804 annually. Assisted living, without the additional services required for memory care, costs about $1,000 less per month. The average cost of memory care around the country is roughly $5,000 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 more than $1,000 less expensive than D.C.’s, at roughly $5,883. Virginia’s prices are close to that, at about $5,704 per month. Read about memory care in Virginia and Maryland.
Every person moving into community residence facilities and assisted living residences must be assessed by a medical professional within 30 days of arrival. In ALRs with memory care, this assessment is conducted by someone who works for the residence. The assessment defines which activities of daily living (ADLs), like eating and bathing, a new resident needs help with. It also does the same for instrumental activities of daily living, like managing money or medications. An individualized service plan is created using the assessed information, which tells staff exactly what help, and how much of it, is required for a new resident.
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 $2,000 and $4,000.
Anyone considering moving into memory care has the right to a document that includes full disclosure of contract terms and the costs of all services provided there. This means there should never be surprises in billing.
Persons with any of the following health or behavioral issues may not move into memory care in the District of Columbia:
– Is dangerous to self or others
– Health problems that exceed services provided at the residence
– Requires more than 35 hours of nursing care per week
– Stage III or IV skin ulcers
– Requires ventilator services
– A disease or condition that requires contact isolation
There is not a requirement in Washington, D.C., that someone be diagnosed with Alzheimer’s or a related disease including vascular, frontotemporal, and Lewy body dementia before moving into memory care.
Residents’ 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 not per-person square footage requirements beyond those for two people, regulations say that up to four people can live in one room. Inspect for yourself to make sure the space is adequate before moving in. There must be one bathroom for every six residents.
You also should inspect spaces 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 undergo an 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 inservice 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.
Very broadly, 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: if a residence cannot admit people who are non-ambulatory, then someone who loses their ability to walk would need to find a more appropriate place to live.
But how and why a person can be evicted or discharged is not defined in regulations, and residences have some freedom to come up with their own policies. It is very important to be clear on these policies before signing a move-in contract, because unfair evictions are a major problem in assisted living. 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.) 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 next steps if your loved one receives an eviction notice, click here.
This is a Home and Community Based Services (HCBS) 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 $2,382 in 2021 (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.
Their higher rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) mean veterans are statistically more likely to develop dementia. Relevant in all states including the District of Columbia 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 income improvement pensions (also called “enhanced monthly benefits”) 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 D.C., which are facilities providing long-term residential care for veterans. In addition to nursing home care and assisted living, the Armed Forces Retirement Home provides memory care with specially trained staff in a controlled environment. 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%from their 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 more information and contacts, 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. This might be a good idea if, for example, one is waiting for a VA pension to be approved or waiting to sell a home.