In Washington state, 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 the following:
– Meals, including nutritious snacks
– Medication assistance
– Arranging for doctor appointments
– Emergency response
Special care units for people with dementia (often referred to as “memory care”) might be a special wing of an existing assisted living residence, or the entire residence itself. A secure outdoor area must be provided in Washington memory care, because time outside has been shown to benefit people with dementia. There are more assessments required for people in memory care than in regular assisted living, and staff needs additional training to help 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). There are 530 memory care homes in Washington. There are also 105 board and care homes, which offer the same services as assisted living, often including memory care, to 12 or fewer residents in a smaller, more house-like residence. For free help 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 Washington is $6,780, which is about $81,360 annually. This makes Washington relatively expensive compared to other states, as the national average for memory care is roughly $5,000 per month. Assisted living, without the additional services required for memory care, costs about $1,000 less.
The most expensive place for memory care in Washington is also its most populated city: In Seattle, memory care costs roughly $7,964 per month and $95,568 per year. Spokane’s average memory care costs are $5,991 per month and $71,892 annually. The least expensive city for memory care is Walla Walla, which costs about $4,484 per month and $53,808 annually.
Residents of western and southern Washington, including the coastal and south Puget Sound regions of the state, might consider Oregon for memory care if cost is their biggest factor. Oregon’s memory care averages much less, at about $5,488 statewide and $5,704 in Portland. Eastern Washingtonians could likewise consider memory care options in Idaho, for the much less expensive average monthly price of roughly $4,341.
An assisted living facility in Washington can only admit a person if its services will 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 your loved one is a good fit. For example, policies on Medicaid assistance (see Financial Assistance 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. These assessments are usually performed by medical professionals who work for the residence. They determine unique needs, including exactly which ADLs a new resident needs help with, to make sure the home is a good fit and also prepare a personalized service plan. The plan works like a blueprint that tells staff the best way to help your loved one. The cost of assessment might be included in the base rate, or there may be a “community fee,” which is a one-time payment at the time of move-in that covers costs like the assessment and also preparing a new resident’s room. Community fees are usually between $2,000 and $4,000.
A person does not need to be diagnosed with dementia to move into memory care in Washington state. Alzheimer’s and related diseases including frontotemporal, Lewy body, and vascular dementias are difficult to diagnose (expensive tests like PET brain scans are required), and the assessment will give the residence a good idea of whether your loved one needs memory-care services.
And while it might be possible to move into memory care on short notice in Washington, this is not a good idea. Finding the right memory care community is a process that should take weeks or months of investigating options by taking tours and asking questions of residents and staff in homes that might suit your needs. Ideally, you would begin searching before a move becomes necessary. The sooner the search begins, the more input the person with dementia can provide.
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.
Washington regulations do not include a requirement that buildings be designed with other dementia-friendly features like easy-to-navigate layouts with clear sightlines, or bright lighting and paint colors. Studies have shown that the right dementia-care design can improve mood and encourage participation in activities. As you look at options for your loved one, keep an eye on whether they’ll be comfortable and able to thrive within the spaces.
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.
A resident of Washington memory care will be evicted or discharged if the residence cannot meet their medical needs. If someone develops a condition that requires long-term nursing care, for example, then they would need to leave because continuous nursing care is beyond the scope of what’s offered in Washington memory care. (Nursing care is allowed for up to 14 days if the residence is suitably equipped.)
Another reason someone in Washington can be evicted is if they become non-ambulatory (lose the ability to walk), and the residence is not approved by a state director for fire protection to admit people who cannot walk.
Washington regulations do not provide details on the process of eviction. It’s important to be clear on these rules before agreeing to a move-in contract, because unfair evictions are a major problem in assisted living nationwide. If you are considering a community, ask specifically why and how a person can be evicted. What is the time between receiving an eviction notice and needing to move out? (Thirty days is standard.) How do you appeal? Can someone be kicked out for late payment of bills, or aggressive behavior? Get the answers in writing, so you’re prepared if a dispute comes up about your loved one being asked to leave. If you receive an eviction notice in a Washington memory care home and need to know next steps, click here.
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 $794 per month in 2021 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 “attendant care,” including activities of daily living like 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. More information is available here.
COPES is a Medicaid waiver program in Washington 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 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. 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 whose health is considered “stable and predictable.” 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. A training RN will periodically check in with the caregiver to make sure tasks are being performed correctly and their loved one’s health remains stable and predictable. To learn more, click here.
Higher rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) make veterans 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 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 four veterans’ homes in Washington, which are residential care facilities that provide long-term care for veterans. They are:
– Washington Veterans Home, Retsil (on the Puget Sound)
– Washington Soldiers Home & Colony, Orting (near Mount Rainier)
– Spokane Veterans Home
– Walla Walla Veterans Home
In addition to nursing home care and assisted living, 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. For contacts and more information, click here.
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.