Memory Care in Alabama

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

Alabama seniors pay $3,250 per month on average for assisted living, which is roughly $800 below the national average of $4,051. Based on this statewide average, families can expect to pay between $3,900 and $4,225 for memory care in this state, though some regions may be more costly or affordable.

The cost of assisted living and memory care varies widely across the state. The most financially economical city for assisted living in Alabama is Gadsden, where the average cost of care is $2,500 per month, and the costliest city is Auburn at $4,145. In the state capital of Montgomery, assisted living costs are about $100 lower than the state average at $3,134. Memory care typically costs an average of $500-$1,244 on top of assisted living fees, depending on the location and the facility’s amenities.

Alabama Medicaid Programs for Memory Care

Medicaid Elderly and Disabled Waiver Program

The Medicaid Elderly and Disabled Waiver Program enables seniors to delay nursing home placement and continue living at home or in a residential community. It provides financial assistance for on-going personal care services, and program participants can self-direct their care and select their own caregivers, including friends or relatives. Services covered by this waiver program include case management, personal care, homemaker services, companion services, adult day services and nutrition and meals. The number of services a program participant receives is determined by the level of care they need and how much help they already receive.

• Who Is Eligible: To be eligible for this waiver program, applicants must meet Alabama Medicaid’s financial and residency guidelines and require the level of care provided in a nursing facility.
• How to Apply: To apply for this waiver program, eligible seniors should contact their local Area Agency on Aging or call 1-800-AGELINE (1-800-243-5463) to reach their county’s Area Agency on Aging and Aging and Disability Resource Center.

SAIL Waiver Program

The State of Alabama Independent Living Medicaid Waiver, or SAIL, helps individuals with neurological conditions, such as Parkinson’s or Alzheimer’s disease delay nursing home placement by paying for in-home services. This program is operated by the Alabama Department of Rehabilitation Services and covers a wide array of services, including assistive technology, medical supplies, personal care, case management and personal emergency response systems. A Medicaid-certified home care agency must provide the personal care services. Alternatively, if the program participant’s geographic region does not have a certified home care agency or if they enroll in the Personal Choices program, they may coordinate their own care and hire friends, family or neighbors to provide care services.

• Who Is Eligible: To be eligible, applicants must be at least 18 years old, and the onset of their disability must have occurred prior to age 60. They must qualify for nursing home care and meet the state’s Medicaid eligibility guidelines pertaining to residency, income and assets.
• How to Apply: To apply for this program, eligible applicants should call the Alabama Medicaid office at 1-800-362-1504.

ACT Waiver Program

The Alabama Community Transition Medicaid waiver program, or ACT, enables seniors with early- to mid-stage Alzheimer’s disease to transition out of a nursing home setting and into their own home or the home of a friend or relative. This program is available to seniors who are enrolled in the SAIL or Elderly and Disabled waiver program, but aren’t receiving an adequate level of care. It offers a variety of services and benefits to promote the participant’s independence, including home modifications, personal care services and adult day health care. Participants have the option of directing their own care and hiring family members or friends to provide care.

• Who Is Eligible: To be eligible for ACT, applicants must be Alabama residents and be at least 65 years old or designated as disabled by the Social Security Administration. They must also qualify for and currently be receiving nursing home-level care in an institutional setting. Alternatively, they must be receiving services under a Medicaid waiver program.
• How to Apply: Eligible seniors should contact the Alabama Department of Senior Services at 1-800-243-5463 to apply for this program.

Non-Medicaid Financial Assistance Programs for Memory Care in Alabama

Support for Family Caregivers (CARES)

The Alabama Cares Program provides support for caregivers of individuals with dementia, helping them deal with the negative impact that their role as caregiver has on their own health and well-being. It provides service in five basic areas, including information on resources and services available in their community, caregiver access assistance, education or counseling, respite services and supplemental services, such as meals and assistive technologies. While this program doesn’t have income limits, priority is given to those with the greatest economical needs and those who are caring for someone with Alzheimer’s disease or a similar form of dementia.

• Who Is Eligible: To be eligible for the CARES program, applicants must meet one of the following criteria:

• • Be a primary caregiver of an older adult aged 60 or over
  • Be a primary caregiver of someone with Alzheimer’s disease or dementia
  • Be a grandparent or nonparent relative aged 55 or older caring for children under 18 years of age
  • Be a grandparent or nonparent relative aged 55 or older caring for an adult child with severe disabilities

• How to Apply: To apply, caregivers should contact their local Area Agency on Aging at 1-800-243-5463.

More Ways to Pay for Memory Care

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It’s best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs, such as memory care. More information about these programs can be found on the VA website.

• Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.

Memory Care Regulation

In Alabama, memory care services are provided in specialty care assisted living facilities, which are assisted living facilities that accommodate residents with severe cognitive impairments. These facilities are licensed by the Alabama Department of Public Health and certified by the Board of Health. They are monitored through random inspections by the Board of Health, and they must renew their licenses on an annual basis.

Facility Scope of Care

Prior to admission, specialty care assisted living facilities must screen prospective residents to evaluate their clinical history, mental status, physical function and behavioral health. Facilities must provide assistance with the activities of daily living, health monitoring and services and medication services. These facilities are also required to implement a daily activity program to meet residents’ individual needs and provide general observation and health supervision to track changes in health condition, or physical or cognitive abilities.

Admission Requirements

While specialty care assisted living facilities may admit a wide range of residents, there are certain restrictions as well. The below table gives an overview of admission requirements.

Care Plan Requirements

Within 30 days prior to admission, a prospective resident must have a medical examination conducted by a physician, and a plan of care must be developed by the facility, the client and if appropriate, the client’s sponsor. Each resident is given an annual physical exam and monthly assessments by the facility that identifies changes to their weight and ability to self-administer medication. Additionally, comprehensive assessments must be completed for residents who experience a decline in health status or behavior, significant weight loss, two or more falls in a 30-day period, adverse reactions to prescribed medications, harmful behavior or an accident that results in an injury.

Medication Management Requirements

A resident may keep, manage or self-administer their own medications if they have a physician’s order, or they may receive assistance with self-administration by any assisted living facility staff member. Medications that are managed and kept in custody by the facility must be unit-dose packaged.

A resident in a specialty care assisted living facility who is unable to self-administer medications may have medications administered only by an RN, a physician or an LPN who is currently licensed in Alabama.

Facility Requirements

Units in specialty care assisted living facilities may be single or double occupancy. Bathrooms and bathing facilities may be shared, and there must be at least one bathtub or shower for every eight residents and one toilet and sink for every six residents. Facilities must have a secure perimeter to safely accommodate residents who may wander. Exterior doors must have either panic hardware or electrically controlled door hardware, and locks on exterior doors must be electrically locked or electrically delayed-egress locking devices.

Staffing Requirements

Specialty care assisted living facilities must have an administrator, a medical director, at least one RN, a unit coordinator and a staff of personal care providers. Minimum staffing levels depend on the size of the facility and the time of day, but there must be at least two staff members on duty at all times. If necessary, the facility must exceed minimum staffing requirements to ensure residents’ needs are met.

There must be at least one CPR-certified staff member on-site at all times, and facilities with an AED machine must have a staff member who has up-to-date certification from the American Heart Association or the American Red Cross in AED utilization.

Medicaid Policy

Alabama doesn’t provide public funding for specialty care assisted living facilities through Medicaid or non-Medicaid programs.

Reporting Abuse

Anyone who has a concern or complaint regarding a resident’s quality of care or treatment in a specialty care assisted living facility should contact the state’s Long-Term Care Ombudsman office. Complaints can be filed in writing, over the phone or in person by contacting the local Area Agency on Aging office.