There are three types of assisted living residences in Wisconsin: 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. According to state regulations, two of these types of homes must follow certain rules in order to house people with dementia. 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’re willing to take to serve folks with needs specific to dementia. CBRFs, for instance, must have daily structured activities that are beneficial for people with dementia. 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.
A service agreement is required for every resident AFHs and CBRFs, specifying the care and treatment that will be given based on personal 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.
The average cost of memory care per month in Wisconsin is $5,704, which breaks down to about $187 per day and $68,568 annually. If your loved one is receiving memory care in an adult family home, the home is required to disclose all charges and fees as part of its service agreement, so there should be no billing surprises. In a community-based residential facility, you’ll want to ask about all conceivable costs before moving in, and get it in writing. Assisted living, without the additional services required for memory care, costs Wisconsinites about $4,359 per month and $52,308 annually.
The state’s most expensive place for memory care is Oshkosh, where memory care costs about $7,179 per month and $86,148 annually. The least expensive city for memory care is La Crosse, for about $3,390 per month and $40,680 per year. In Milwaukee, by far the state’s biggest city, memory care costs about $5,863 per month and $70,356 annually. The costs in Madison are $5,185 per month and $62,220 annually.
CBRFs may only admit residents who have been assessed and found compatible with the services provided there. 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)
In AFHs, new residents must have health assessments within 90 days prior to admittance or seven days after. Each resident must enter into a 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
A written service agreement identifying an individual resident’s needs and abilities must be completed within 30 days of admission to an AFH.
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.
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.
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, including a monthly income limit of $2,313. For more information, visit the program’s website here. To enroll, contact your local Area Agency on Aging. 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.
Veterans are statistically more likely to develop dementia. Relevant in all states including Wisconsin 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 Wisconsin, 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 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.