In Wisconsin regulations, there are three types of assisted living residences: community-based residential facilities (CBRF), residential care apartment complexes (RCAC), and adult family homes (AFH). There are differences between them, but broadly they all provide housing, supervision, and services including some medical help to communities of people who are typically elderly and have some kind of illness.
Two of these types of homes may house people with dementia if they follow certain rules. CBRFs and AFHs can have residents with Alzheimer’s disease or another dementia (this type of housing is often called memory care) if they articulate to the state what further steps they take to serve folks with needs specific to dementia. CBRFs, for instance, must have daily structured activities that are beneficial for people with memory loss and other symptoms including social withdrawal. AFHs must develop a program statement that describes how many people with dementia the home can take in, and how the residence will go beyond normal assisted living to serve their needs.
Because RCACs cannot admit someone under guardianship, or who has difficulty recognizing danger or making care decisions, this type of housing may only be good for someone in the early stages of Alzheimer’s. RCACs are, therefore, not a good long-term housing solution and should probably not be considered as memory care. If someone with early-stage dementia does move into an RCAC, a move into memory care will eventually be necessary because dementias are progressive diseases (meaning they worsen over time).
A service agreement is required for every resident in AFHs and CBRFs, specifying the care and treatment that will be given based on unique personal and medical needs. Residents are assessed around the time of move-in, though in AFHs they’re assessed for compatibility with the residences’ programs and in CBRFs they’re assessed to create a more personalized service plan.
Memory care in Wisconsin is regulated by the Division of Quality Assurance’s Bureau of Assisted Living. There are 60 memory care homes in Wisconsin. There are also more than 1,000 board and care homes, which offer the same services as assisted living (sometimes including memory care) in a smaller, more house-like environment for fewer than 12 residents. For free assistance 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 Wisconsin is $5,201, which is about $62,412 annually. Assisted living, without the additional services required for memory care, costs Wisconsinites about $1,000 more per month. The national average for memory care is roughly $5,000, so Wisconsin is on the slightly more expensive side, but costs can vary widely.
Wisconsin’s most expensive place for memory care is Appleton, where memory care costs about $6,493 per month and $77,916 annually. The least expensive city for memory care is La Crosse, for about $4,520 per month and $54,240 per year. In Milwaukee, memory care costs about $5,991 per month and $71,892 annually. Other Wisconsin cities with memory care costs:
|Wisconsin Memory Care / Assisted Living Costs (updated April 2021)|
|Region / City||Monthly Cost||Annual Cost|
It might be possible for people who live in western Wisconsin to find more affordable memory care outside the state. Minnesota has a slightly less expensive overall average ($5,058 per month) but big savings can be found in a town like Rochester, which is only about an hour from La Crosse, Wisconsin, and costs an average of $3,659. Iowa’s average cost is less than Wisconsin’s, at roughly $4,807 per month, so savings could be found in that state as well. To the south, Illinois’s costs are higher than any of these surrounding states, at about $5,381 per month. Prices can vary so widely, however, that investigating communities in surrounding states is a smart way to potentially save money.
CBRFs may only admit residents who have been assessed and found compatible with the services provided there. Assessments are made by a medical professional who works for the residence, usually a nurse, to determine someone’s personal preferences and medical needs so that staff can effectively help and communicate with the resident while also maintaining their health and safety. Specifically, a person’s ability to perform activities of daily living (ADLs) like bathing and eating would be assessed, as well as their stage of dementia.
The cost of assessing may be included in the residence’s base rate, or there may be a “community fee” that covers move-in costs including the assessment and also preparing a new resident’s room. Community fees usually run between $1,500 and $2,500.
In AFHs, new residents must have health assessments within 90 days prior to admittance or seven days after. The process is similar to CBRFs, where someone working for the residence does the assessing and determines mental and physical abilities to create a detailed service agreement that specifies the following:
– Services that will be provided, with descriptions
– Charges for room and board, services, and any other fees
– Payment method
– Conditions for transfer or discharge
The service agreement must be completed within 30 days of admission to an AFH.
Residents may not be admitted who are:
– Confined to bed
– Threatening or destructive to property or self
– Physically or mentally abusive (unless facility can ensure protection for others)
– In need of more than three hours of nursing care per week
– In need of restraints (unless a waiver is granted by state)
A diagnosis of Alzheimer’s (or related disease including vascular, frontotemporal, or Lewy body dementia) is not necessary for a person to move into memory care in Wisconsin.
No more than two residents are allowed in a single bedroom unit in either AFHs or CBRFs. The square footage requirements are slightly different. A CBRF bedroom must be, at a minimum, between 60 and 100 square feet, depending on whether the resident is ambulatory, semi-ambulatory, or non-ambulatory (basically, how well your loved one can move around). An AFH bedroom must be 80 square feet for one person and 120 square feet for two. If an occupant is in a wheelchair, the unit must be at least 100 square feet. Every CBRF must have a toilet, sink, and bathtub or shower for every 10 residents. In AFHs it’s those same facilities for every eight residents. The doors of every AFH bathroom must unlock from the outside in case of emergency. Grab bars must be around the toilets and baths in an AFH. Smoke detectors must be in and around all rooms in assisted living residences in Wisconsin.
Unlike many states, Wisconsin regulations do not specifically call for dementia-friendly architectural features in memory care communities. Examples of design elements that have been shown to benefit people with dementia include clear sightlines and layouts, a secure outdoor area, and bright lighting and paint colors. Watch for these while taking tours of potential memory care homes, keeping an eye on whether your loved one will feel comfortable within the spaces.
There are no staff-to-resident ratios in Wisconsin assisted living, except to say that any residence must be adequately staffed to meet the needs of every person there. One employee must be awake at all times. In CBRFs with memory care, staff must receive dementia-specific training within 90 days of hiring. The training must specifically address the needs of people with dementia and include the following:
– Residents’ physical, social, and mental health needs
– Medications or treatments
– Program services to help people with dementia
– Meeting needs of someone with dual diagnoses
– Maintaining or increasing social participation, self-direction, and self-care
That sounds somewhat general, but the important point is that these facilities must specifically identify the types of residents they can serve, and then create a training regime to enforce this.
Administrators in either type of facility must be at least 21 years old. At a CBRF, the administrators are required to have had relevant educational or professional experience. Administrators don’t need to meet the same experience benchmarks in an AFH, but do need a clean criminal background check.
Someone being evicted or discharged from memory care in Wisconsin must be given 30 days notice before they need to leave. Broadly, no one may continue living in any type of assisted living home if the staff cannot handle their medical condition. Someone who develops a need for 24-hour nursing care, for instance, cannot remain in memory care and would need to be transferred to a nursing home or hospital. Another example: if a residence cannot admit people who are non-ambulatory, then a resident who loses the ability to walk would need to find a new home. Behavior that is dangerous to one’s self or others can also justify being evicted or discharged from memory care.
These are vague general regulations, however, and individual homes should have their own specific rules. It is very important that you fully understand the reasons a person can be evicted, and what the process is, before agreeing to a move-in contract, because unfair evictions are a major problem in assisted living. Ask all the questions you can (Can someone be evicted for late payments? What about verbal abuse?) and get answers in writing. If your loved one in Wisconsin memory care receives an eviction notice and you need to know next steps, click here.
This program is designed to help people live more independently, outside of a hospital or nursing home. For people who live in their own homes, funds from the program may be spent on hiring a caregiver, but in assisted living (regardless of type) Family Care benefits can apply to costs that come up day-to-day, like medical equipment, occupational therapy, and personal care. Two former Medicaid waivers have been folded into this program: the Community Options Program Waiver (COP-W) and the Community Integration Program II (CIP-II). Eligibility requirements are the same as Medicaid, so limits on income and assets apply. For more information, visit the program’s website here. To enroll, contact your nearest Aging and Disability Resource Center. The ADRC will visit your loved one and fill out a Long Term Functional Screen that determines needs and helps them know what other benefits might be available. Family Care has expanded to be available state-wide.
Also called Medical Assistance Personal Care, Wisconsin Medicaid Personal Care is a program in which a person’s needs are assessed by a state agent who visits their home (which can include a bedroom unit in assisted living) and determines what costs the state can help cover to keep someone as independent as possible. Personal care is generally defined as assistance with ADLs. To be eligible, your loved one must be enrolled in Wisconsin Medicaid. The application to apply can be downloaded here, or you can apply through the state’s ACCESS website.
Eligible recipients, who have been found to require 40 hours weekly of supportive services or in-home care, can receive $95.99 (or $345.36 for couples) on top of their regular Wisconsin Supplemental Security Income (SSI) benefit. People in assisted living are eligible. To apply, contact your local office for the Department of Health Services. For more information, click here.
In part due to higher rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), veterans are statistically more likely to develop dementia. Relevant in all states including Wisconsin is the VA’s Aid & Attendance income improvement 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 (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 three veterans’ homes in Wisconsin, which are residential care facilities that provide long-term care for veterans. They are located in King (west of Oshkosh), Union Grove (south of Milwaukee), and Chippewa Falls (outside Eau Claire). In addition to nursing home care and assisted living, memory care is 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 a limited number of beds are available, 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 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 the spouse move from 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.