The two types of communities in the District of Columbia 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.
ALRs must provide recreational and social activities. Other health and social services that should be made available to people in assisted living residences include:
– Social work
– Home health
– Psychiatric help
The average cost of assisted living with memory care in Washington, D.C., is $6,701 per month, which breaks down to about $220 per day and $80,412 annually. Remember that a list of all costs and fees should be provided by any residence to people interested in moving in. Assisted living, without the additional services required for memory care, costs residents of the District of Columbia about $5,121 per month and $61,452 annually. 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. 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 used to develop an Individualized Service Plan which specifically names the services a person will require there. 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.
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
Resident’s 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.
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 (which regulates assisted living in D.C.). 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.
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 $2,349 (though there may be help available for those who don’t meet requirements including the monthly income cap). For more information, click here. To apply, 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. 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 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 (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive $14,761. Learn more here.
There is also one veterans’ homes in D.C., which are facilities providing long-term residential 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 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 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.