Residences that provide room and board and healthcare services to people with Alzheimer’s disease (or related dementia) are called assisted living facilities with special care units. Broadly, these communities offer these services:
– Meals, including nutritious snacks
– Medication assistance
– Arranging for doctor appointments
– Emergency response
Special care units for people with dementia must also provide a secure outdoor area. There are more assessments required for people in memory care, and staff needs additional training to address the needs of people in various stages of dementia. (For more on assessments and staff training, see below.)
Assisted living facilities in Washington are regulated by the Washington State Department of Social and Health Services, Aging and Long-Term Support Administration (HSHS/ALTSA).
The average cost of memory care per month in Washington is $7,219, which breaks down to about $237 per day and $86,628 annually. Costs are required to be entirely disclosed in residential agreements in Washington, including all charges and any possible fines or penalties, so there should be no surprises. Assisted living, without the additional services required for memory care, costs Washington residents about $5,517 per month and $66,204 per year. The most expensive place for memory care in Washington is also its most populated city: In Seattle, memory care costs roughly $8,535 per month and $102,420 per year. The cheapest cities for memory care are Spokane and Walla Walla, which both cost about $5,265 per month and $63,180 annually.
An assisted living facility in Washington can only admit a person if its services can adequately meet that person’s needs. This seems obvious, but every memory care community is different, and they all must produce a full disclosure on the care and services provided, on a standardized form. You’ll want to scrutinize it to make sure it’s appropriate for your loved one. For example, policies on Medicaid assistance (see below) may differ, and some homes offer intermittent nursing services and medication administration while others do not. It’s a good idea to get these forms from homes you’re considering, and then compare them. The disclosure must include:
– Food and diets
– Services related to arranging and coordinating healthcare needs
– Level of assistance with ADLs
– Intermittent nursing services
– Help with medications
– Transportation services
– Rules related to smoking and pets
– Limitations on end-of-life care
– All charges and costs
– Bed hold policy (whether your spot will be held if an extended hospital stay is required)
– Policy on accepting Medicaid
– Buildings’ fire prevention features
– Security services
They are also required to disclose the full scope of services provided to people with dementia.
Someone who is nonambulatory (cannot walk without assistance) may not be admitted without special permission from the state, nor can an assisted living home take in residents who require full-time nursing care. A preadmission assessment is required before moving into memory care, and then a more detailed assessment must be done within 14 days of beginning residence there.
Bedrooms must be at least 80 square feet for one occupant, and 70 square feet per person for multiple occupants. The maximum number of people per bedroom is two (unless the residence was licensed before 1989). One toilet and sink is required for every eight residents, and one shower or bath is required for every 12. There must be smoke detectors in every room, as well as manual and automatic fire alarms. Emergency lighting and a disaster plan are also required. Facilities that offer memory care must make sure visitors can exit without sounding an alarm, and provide an appropriate outdoor activities area.
There is no specific staff-to-patient ratio, but memory care homes must obviously ensure that they have adequate staff at all times to meet the needs of every resident. Fingerprint-based background checks are required of all new hires.
Memory care homes must provide special training for staff to meet the needs of people with dementia, toward an outcome defined by that residence and approved by state regulators. Orientation and safety training are also required before someone can begin work in assisted living. Twelve hours of additional training is required every year.
Administrators are responsible for operations 24 hours per day. An assisted living administrator must be at least 21, with education, training, and experience that meet the residence’s state-approved requirements. Continuing training on state statutes related to assisted living is also required.
Though it won’t cover room and board in assisted living, the Washington Medicaid Personal Care (MPC) program is for people, including residents in memory care, who need help with costs associated with activities of daily living including bathing, dressing, and eating. (Washington Medicaid is also called Apple Health.) Nursing services can also be covered, including assessments and skilled treatment. Eligibility rules are stricter than typical Medicaid, including an income limit of $771 per month for an individual. Enrollees must already be part of the Medicaid program. Speak with your case manager about joining MPC, and for more information visit the state’s MPC site.
CFCO is another Medicaid program that helps pay for services which are not room and board. A key difference between CFCO and the MPC (above) is that eligibility guidelines are not as strict for CFCO. People in assisted living who receive financial assistance through this program likewise are meant to use the funds for help with activities of daily living including bathing, dressing, and eating. Meal preparation, medication assistance, and some nursing care are also covered. Someone enrolled in CFCO can receive assistance from other Medicaid programs in Washington. A person must already be in the Medicaid rolls to sign up for CFCO. Anyone interested in applying should contact Washington’s Aging and Long-Term Support Administration.
COPES is a Medicaid waiver program in Washington meant to help people who might need nursing-home-level care stay in their own homes or assisted living residences. The funds provided by COPES may also be used to pay costs of moving into assisted living. Anyone considered for COPES must also qualify for Medicaid. Many of the benefits are similar to MPC and CFCO above, but eligibility requirements differ. COPES enrollment is capped, so there may be a waiting list. For more information and to apply, click here.
Residents of King and Pierce counties (which include Seattle, Tacoma, and Bellevue) may be eligible for the New Freedom Medicaid waiver, which helps cover costs for someone who requires full-time nursing care but wants to stay at home or in assisted living. This program is an alternative to those listed above, and offers more flexibility. The state collaborates with the person in need to determine expenses which might be appropriate for coverage, including assistive technology and preventative medical care. Recipients must be Medicaid-eligible. For more information, click here.
Washington’s Nurse Delegation Program is a Medicaid program that trains a caregiver (who must be licensed with the state as a nursing assistant) how to administer nursing-home-level care to someone outside of an actual nursing home. The goal is to keep people in their houses, rather than in expensive nursing homes, but the program can also apply to someone in assisted living. To learn more, click here.
Veterans are statistically more likely to develop dementia. Relevant in all states including Washington 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. 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 Washington, 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 assisted living with 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 out of 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.